The Successful Fellowship Interview

Take a seat for a moment. Imagine you're the program director of a big fellowship program during the interview season. What would you want in your new fellow? Intelligent, diligent, committed, resourceful, team player, great fit at my program, outstanding ambassador for my program etc.

Now imagine you're trying to get hitched on a dating website. What do you want in a partner? Loving, smart, successful, funny,compatible, will get along with my family and friends. Do you see any similarities with the director?

The fellowship interview is like dating. Your partner has to find reasons why (s)he thinks (s)he's found The One.
How do you make this happen?
Simple. Four steps: Know the program. Know yourself. Find common ground. Prepare for questions

Now let's go through each step.

Research the Program
Read everything about the program, the faculty, hospital and city.
What is the history of the program? Any areas of excellence? Who are key faculty?
Read extensively about the faculty- their education, committee memberships, research, voluntary work, hobbies. This is a very important way of finding common ground. For example, I found out that my mentor trained together with a couple important faculty at a program I was interviewing at.
You should study the curriculum. How does it differ from other programs?
What's unique about the hospital? What's the demography of the city?

Research Yourself
Read your personal statement. Read your CV. Anything exciting or questionable (like gaps in training)? Be prepared to discuss any part of your CV or personal statement.
I learned more about myself during the interview trail. Even if you've made up your mind about where you want to match, I think going on several interviews is worth it. Enjoy meeting new people, enjoy the cities, and most of all enjoy getting to know you.

Find Common Ground
Here, you're creating a bridge between what you learned about the program and what you learned about yourself.
I will address this some more in the next section.

Prepare for Questions
There are 3 types of interview: the highly structured, the semi-structured, and the seemingly informal interview. Be ready for any of these. You're the salesman. You will adapt to the interview structure and pitch your talents. Be deliberate and honest. Back up your statements with examples.
Here are 9 questions that could be worth preparing for:

1. Why did you apply to our program?

Tips: Focus on the program's virtues. Don't start with city, weather etc. Be specific. You can talk about what you like about the curriculum, mentors with similar research interests etc.
You might also use this opportunity to throw your mentor's name out there. Here's an example I once used: "My mentor Dr. xx recommended that I apply to this program. She told me great things about the program and coming changes that the new Chair, Dr xx (a former colleague of hers) is bringing. This is definitely an exciting time to be a part of this program".
If you have family ties, you can add this. Ties are very important, but they're an add-on, not a prime reason.

2. Tell me about yourself

This is very often the ice breaker. There are many ways to answer this question.
I have started with "I grew up among 4 boys. This experience nurtured a competitive edge in me..."
I have also started with "I am currently a 2nd year..."
Think about this question like you've got first serve in a tennis match.
You can totally decide where you want the conversation to lead, and you should; serve to your areas of strength.

3. Why did you chose this specialty?

Try to be original. You don't need to repeat your personal statement verbatim. Don't appear like you're reading off a rehearsed speech.

4. What are your strengths and weaknesses?

Give genuine answers with examples. Be careful not to give weaknesses that will drown you (I am always late, I don't have much motivation etc.).
An example I once gave was that I didn't like to fail and I was very hard on myself. Of course I didn't end there. I explained examples of times that I have actually learned from my failures and how I have come back stronger.
Couple every weakness with how you have improved on it.

5. What key skills do you have?

Give unique skills. With examples of course. Maybe you can communicate in difficult situations? You speak 15 languages?

6. Discuss a difficult/interesting case you once had 

This is not a very common question, particularly for fellowship interview. However, don't be blindsided if you're asked. On the other hand, you can tie this with the 'why this specialty' and 'key skills' question. While discussing this, your goal is to convey attributes like curiosity, out of the box reasoning, resourcefulness or other skills that make you unique.

7. Talk about a mistake you once made

The interviewer is asking you to discuss a mistake and what you learned from it. How has it made you a better physician?

8. What sets you apart? Why should we choose you?

Humbly summarize your strengths and how you fit with the program. Remember it's give and take. Talk about what you're going to gain from the program and how you will benefit the program.

9. Do you have any questions for me?

No, thank you. - Read as 'I am not interested'.
Your default answer is yes. Equivalent of triple match point in tennis or free throws to win a tie game in basketball.
Prepare questions tailored to each faculty.
You should generate questions from the faculty's bio. You can ask questions related to their clinical, research, administrative work or hobbies. You can ask questions about a publication of theirs you read. You might even suggest how your skills can be useful for their research.
Don't ask faculty questions that can be answered by a simple online search, or one that fellows can answer.
Here are 3 of my favorite questions for faculty:
-What do you enjoy most about working here?
-What do you value most in your fellow?
-How do you advise me to improve my current preparation, such that on day one, I'm ready to excel (You should outline the things you're already doing).

Ask fellows the hard questions. Dig deep into the curriculum. Ask about things that matter to you. How is the scut work? Do you feel you get enough autonomy? What are your hours like? Do you think the program supports having a child during training?
This is your chance to know the day to day life of the fellow. You want to make sure the program is the right fit.


Closing the loop

The success of an interview also depends on your communication afterwards. You should thank the faculty, staff and fellows you come across. Emails are fine. Handwritten cards are even better. I typically send both since emails are usually deleted. My program coordinator in residency showed me the handwritten card I sent to her a year later. She kept it!

Some programs like you to communicate your interest after the interview. Those programs will usually tell you this during the interview. At the end of the day, no program wants to match a disinterested fellow. If you think a certain program is your favorite, do let them know. Tell them reasons why you want to match there. Don't sound desperate. Remember, by NRMP rules, there's no quid pro quo. You can tell a program you will rank them, but the're not obliged to do the same, and vice versa.

To summarize, the fellowship interview is the most important factor in the match. Go with your 'A' game. The recipe for winning is preparation, preparation and preparation. Learn everything about the program. Learn everything about yourself. Find common ground. Ask questions. Be courteous.
And finally, if you don't believe in yourself, your interviewer cannot believe in you. Now, go ye and slay!


Feel free to post your comments or questions.

Hakeem Ayinde

Steps to a Successful Fellowship Interview

I was hoping to write this piece later in the year, but after talking to a few fellowship applicants, I decided to put it out before July 15 for their benefit.

There is common knowledge that on average, you need at least 8 interviews in order to match for residency. Well, this is not necessarily true. I'll say you need only 1 interview: the successful interview. Quality>>Quantity.
This article briefly describes the steps you take towards securing the right interview.

After you submit your application, there are several factors that determine whether you will be selected for an interview. These include USMLE/COMLEX scores, visa sponsorship (J>H visa), research/publications, strength of recommendation letters, additional training, chief year etc. The weight applied to each criterion varies by program. Pray the program director reviews your application in his best mood.

Once you're invited for an interview, it is now in your hands.

In order to increase your odds of getting interviews, you have to apply to as many programs as you can afford. This especially goes to IMGs or residents that need visas. Many times you get rejection letters not because you're not qualified, but because there are many other equally qualified applicants.
Choose the programs wisely. If you need a visa, don't apply to programs that don't sponsor visas. If you're on H visa, apply to both H and J programs. You'll sort that out later. Some programs don't sponsor H visas because they're not familiar with the process. You can talk to them about it.

Talk to fellows in these programs. They're a great resource and can give you invaluable advice about your application. In fact, a look at the fellows' profiles on the program website can give you some insight into whether you're the kind of applicant they're looking for.
Caution here to minorities; you may find that there are many minorities in the program (great!) or there are none. Well, it's possible that the program leadership in the latter case just noticed the same and is looking to increase diversity. So, I'll advise that you apply irrespective of program make up.

A really good strategy is to get in touch with programs way before the application process. Link up with faculty with shared research or voluntary interests. Have them review your work. You may be lucky to actually start collaborating with them even before you apply. This is a good head start.

Get your letters of recommendation in early. You don't want programs reviewing incomplete applications. This means requesting letters from up to 5 mentors. You're betting on a 60% timely turnover rate. Make sure the letters are the strongest possible. It's better to get a strong letter from junior faculty than a mediocre letter from eminent faculty. Ask the letter writers if they want you to provide a template. This makes their job easier and it also shows them the achievements that you'd like to highlight.

I don't think a great personal statement will make an application. A bad personal statement can break one.

pleated-jeans.com

Everything I've described above is for one reason only: Getting an interview. Once you score the interview, then most likely you have as good a chance as anybody of getting accepted. You control your own destiny to a large extent on the interview day.

The next article (The Successful Fellowship Interview) discusses how to maximize your match chances during the interview.
Stay tuned.

Hakeem Ayinde

I am a Doctor, I am a Zombie

Among the thousands of patients I have cared for, a few stand out and for different reasons. All of the reasons have one thing in common, however: emotion. I usually separate my emotion from my work, and rightfully so. It is how doctors are trained. Show empathy, provide the best care to the limits of your abilities.
Sometimes, I want to jump and scream with a patient. Like I did when I saw Kyrie's championship winning shot at a bar in O'hare. Sometimes I want to hold a patient's hand and cry with her. One day, I will be in the hospital, not as a doctor, but as a patient or a patient's relative. I do relate to that.
But today, I will stay even keel. Smile and hug, and show concern. And weep only in my heart.
I will not show anger or fear, or judgement. Even if my experience is unsavory.

I have been tested by some experiences, which I have learned from.
I mean, what do you do when a patient detests you. Twice in my few years of practice, I've had patients that told me they don't like me. One was a middle aged lady who came in with an acute heart attack. She looked me in the face and said she did not like me. Err.. Ma'am you're having a heart attack and I am here to help you. No, I'll get help from any other person, she said. Her brother later told me she had borderline personality disorder, and she decides who she likes on first contact.
The second time it happened to me, I didn't think it was a personality disorder problem. I was asked to see Broderick, a middle aged gentleman with a heart condition. I don't know what ticked Broderick off, but he just plainly told me he didn't think I was competent. I wanted to talk about why he thought so but he just wanted me out of his room. I felt sad for him.
An even more interesting interaction was one I had with an elderly Caucasian gentleman. He had acute heart failure and I had been consulted by his doctors. I walked into his room, along with a resident I was mentoring.
 "Good evening Mr. James. I am Dr. Ayinde and this is Dr xx, and we are here from cardiology to assist your doctors in taking care of you".
"Where are you from, You'r not American", He said. I told him I was Nigerian.
"Well, I'm not sure you can take care of me" was his response.
I explained to him that I could leave, but he would benefit from my expertise if I stayed, so it was his choice. Eventually, we ended up chatting for about 45 minutes, and he told me nobody had ever explained how fluid got in his lungs before. He apologized for being rude and arrogant.

Of course, these are only rare experiences in my daily practice. Far more often, I have beautiful experiences that I have held dear to my heart. Sometimes they may be trivial but they create a special bond. I remember when I shared a hug with Herbert's wife and son after I told them he needed a heart pump because his heart was failing. Actually, I did not remember the hug. His wife reminded me almost a year later, after he got a heart transplant. She said she felt strengthened by the hug and knew things were going to be fine.
I remember Casey giving me a pen after my pen ran out of ink.
Alan who wanted to be discharged early, despite his heart condition not fully improving because he had to go home and care for his disabled wife.
I think about my dear friend, John, who despite suffering from heart failure and awaiting heart surgery, still manages to make me laugh with his crazy jokes.
I remember my conversation with Dwayne about death and dying. And the secrets we shared.

The beauty of medicine is not the diseases, but the people that manifest these diseases. The jovial 80 year old man with severe heart failure. The anxious 20 year old. The sad 46 year old. The woman whose 26 great grandchildren came by her bedside to wish her well. I truly enjoy interacting with all of my patients and their families. And I want to celebrate their victories with them.
I want to go jogging with Tom since he stopped having chest pains after he got a stent in his heart arteries. I want to tell Casey that I still have the pen she gave me 4 months ago. I want to feed the wild cats with Alan. I want to have John teach me scuba diving once he improves after his heart surgery.
But I cannot. I am the Doctor in the pristine white coat. Very knowledgeable, confident, calm, stoic and empathetic. I should not be sullied by emotions. Even if, deep inside, I weep..


Hakeem Ayinde

Disclaimer: All patient names used in this article are fictitious.

How to Get into Residency: Part I

Happy holidays to everyone! I appreciate all the feedback on my previous post “5 things to know before choosing a residency program”. Many people have been asking questions about the basic process of applying for residency. Answering this question is very challenging for me, especially since the landscape has changed significantly since the year I applied. For example, many community programs stopped offering ‘prematch’ positions for independent applicants after 2012.

PGY-1 positions have never been more competitive. According to the most recent NRMP match data, 34,270 applicants competed for 26,678 positions in 2014. Between 1999 and 2004, there was a 14.6% increase in applicants, and a 19% increase in PGY-1 residency positions. Although the percentages may look great, the numbers show that applicant growth actually exceeded positions available by 131 in the last 5 years.

What factors determine one’s chances of matching? Let’s crunch some more interesting NRMP stats. In 2014, only about 50% of International Medical Graduates (IMGs) matched, compared to a 94% match rate for US seniors. A US senior that ranked 10 programs would have a 99% chance of matching if he applied to Internal Medicine (IM) and an 88% chance if they were all General Surgery programs. An IMG had a 90% or 59% chance if he ranked 10 programs in IM or General Surgery respectively.

The disparities are even more glaring when you consider the USMLE scores. A US senior with a Step 1 score of 220 had a 96% chance of matching. Conversely, an independent applicant with a similar score had only a 50% chance of matching. A score of 240 would improve would only improve his odds of matching to 73%. Although the USMLE scores are very important (probably the most important), there are many other factors that are important for matching, including publications or presentations, year of graduation and clinical experience for IMGs, additional degrees etc.

The statistics above show that matching for IMGs is very daunting. Do you really need 10 interviews to be guaranteed a high likelihood of matching? By playing the odds, yeah. But how many IMGs get 5, let alone 10 interviews? Obviously, any IMG with 10 interviews has a very competitive profile and would likely match. The reality is that many IMGs, because they don’t have US clinical experience will be sidelined by most programs. I was in a similar situation 3 years ago, and I had to rank only 6 programs. 

Here’s the bottom line: You need to get interviews in order to match. Doing well at the interview is the key to matching, but that’s not the focus of this article. Your application needs to beat the filters that programs have created before you can be considered for an interview. I asked my program director about filters, and he said that it was the most efficient way of selecting the 300 applicants he needed from a pool of 4,000 applications.

Part II of this article will explain the basics of residency application, and common pitfalls to avoid. Keep it locked on for updates.

5 Things to Know before Choosing a Residency Program

This time 3 years ago, I was interviewing for residency positions in Internal Medicine. As a foreign graduate with no US clinical experience, I knew I wasn't going to be cherry-picking at available programs. To make it worse, I had limited my search to the East coast for family reasons. I still remember the frightening experience of refreshing my email 300,000 times for emails from programs. I remember the disappointment of rejection emails, the joy of interview invitations, the what-if-I-don't-match thoughts, the overdrawn credit cards. I remember my excitement when the email read "Congratulations, you matched".

Fast forward to today. I think about my years at Howard and ask myself: what if I had matched elsewhere? How would my life have panned out without the amazing mentors I met? Hard to tell.
Maybe if I knew a few things prior to submitting my rank order list, I would have landed at a different place. Or maybe not.
This piece is directed at those that plan on making a decision soon, or those that still question the decision they made.

1. Are there people like me in the program? This is an important question for minorities. You should talk to people of your culture, color or beliefs in the program after your interview. Remember that every resident you meet will tell you their program is the best. Try to sift through the BS and get a real feel. You want to be at a place where you'd be totally comfortable. You may be more productive at a smaller name program where you're comfortable than at a bigger name where you feel out of place. Point is, understand the situation before you sign up for it.

2. A Yoruba adage says "ona kan o w'oja". This literally means there are many roads to the market. If you are considering a fellowship, you will be better off matching at a University program that has that specialty, so you can work with mentors in the field. If this option is not available to you, an extra year as a Chief resident or research fellow will improve your chances. Additional training in clinical or translational research will improve your chances. A legal permanent residency status will improve your chances. You end up realizing that everyone's profile is different. You should explore the options available to you. This leads to the next point.

3. There are always resources to tap. Some residency programs are highly structured, with specific learning goals and milestones, while others are not. Your goal is to understand what resources are available around you, including renowned mentors, research activities, local and online certificate courses, travel awards, community activities etc. Find out what's unique about your residency program and take advantage of it.

4. Before you start to hate where you match, know this: where you do residency does not matter. Becoming a good doctor depends mostly on you. All residency programs with a good volume of patients are equipped to train you to become a competent internist. Programs with too little volume will not provide the patients you can learn from. Too high volume would not give you time to study and understand the cases you see. The predominant key to success is self motivation, creating learning goals and following through.

5.  The fun does not start after you become a board-certified gastroenterologist. It starts now. Enjoy the programs you interview at, the people you meet at interviews, the cities you get to visit. Most importantly, enjoy the person you are. The interviews help you understand your uniqueness and often give you a clearer idea of what your interests are.

Finally, treat your residency interviews like a first date and you're more likely going to match at the best one for you.

Good luck.

The Electrician

The patient laid unconscious in the intensive care unit bed. The cardiac monitor beeped extra loud. I was here with the Cardiology team to shock this patient. Yes, I mean electrocute. He was in atrial flutter, which meant his heart was beating at an abnormally fast rate and we planned to revert that. Applying a shock to the heart is similar to pressing the reset button on your phone. I had never done one before, and I was eager to earn my stripes on this one. The patient's daughter walked up to me, and asked for the thirty seventh time, "Doc, is his heart rate going to be normal after?". And for the thirty seventh time, I answered "We cannot tell if we would be successful, but we will try. I'll let you know soon as we're done". Since I was the one pressing the button, she assumed I was more important than the intern that I really was.
My Attending directed me to set the defibrillator energy at 200 joules, and the mode to sync. We again checked that the patient was deeply sedated. I pressed the charge button. "All clear on three, two, one"  Bzzzzzzzzz. The power surge forced him to twitch once. The monitor went flat line for 2 seconds. Then, "Beep, Beep, Beep, Beep, Beep". Yes, we did it!!! He was back in sinus rhythm (normal heart beat). That was the coolest thing I ever did. I have done two more since then, and they both felt as good as the first time.

I have only shocked unconscious patients, so I don't know how they felt getting electrocuted. One day, I asked a patient who received a live shock. Live shocks can happen in patients who have defibrillators implanted in their chest because of a weak heart. Anytime the device senses a ventricular fibrillation (a fatal abnormal heart rhythm), it delivers a shock. Sometimes, the defibrillator senses wrongly and shocks the patient inappropriately. So, I met this patient who had received 3 inappropriate shocks in 2 weeks. "How does a shock feel, Mr. J", I asked. "Doc, each time, it feels like a horse kicking me in the chest, and it knocks me down flat. I feel the pain for one week". Okay, lesson learned. Now I'm a believer. My Attending had told me that patients that get shocked alive can get post traumatic stress disorder. Maybe he was making it up. Or maybe it's true.
I have made up my mind, I want to be an electrophysiologist. I would have the license to shock people. We had a patient the other day who had abnormal heart rhythm. The EKG recorded a wide complex tachycardia (fast heart rate). To find out the source, the electrophysiologist took him to the lab. He paced the heart and induced the same tachycardia. He then shocked the patient back to sinus rhythm. Coolest human experiment ever. 
The heart pumps because it is supplied by electricity. The electricity is produced by a generator called the sinus node. It then travels to the rest of the heart via cables, called the conduction system. Abnormalities can occur in either of generation or conduction of electricity in the heart. The problems are fixed by an electrophysiologist. So, an electrophysiologist is basically an electrician. He works with electrodes, fuses, pliers, and screwdrivers. Okay I'm joking about the last three. 
For now, I am a second year resident. At least five or six years separate me from my dream. But I eagerly wait for that day when I will fill out a form. And in the occupation section, I will write "Electrician".

Hakeem Ayinde, MD