The Residency Interview - Some Tips, Questions to Prepare for

Your application is in and now you just wait for the interview requests (and rejections) to roll in. Sometimes you get a wave of interviews right in the beginning, sometimes things stop all together and then there may be another wave later one. It's hard to tell. Everyone, every program, every specialty is different.  But you will get interviews and rejections from the moment you submit your application till the end of January.

Once you get that interview you have to decide how important that program is to you. If you're getting many interviews and have a lot of great options, I would schedule interviews you care less about earlier to use as a practice run. Personally, my first interview was easily my worst interview. I was nervous, I did not have any cases prepared, and I was just unsure of how the day would be. After a couple of interviews, I got the hang of it and I definitely hit my stride. On the other hand, if you get few interviews and every single interview is important and you have to nail it every time, I'd schedule them a little later to allow for more time to practice with friends or family.

The following are the most frequently asked questions I encountered on the interview trail.
Questions to prepare for:
1. Tell me about myself.
2. Tell me about your medical school
3. Why the Caribbean?
4. What are your strengths? Your weaknesses?
5. What do you like to do for fun?
6. What do you anticipate being the hardest part about residency?
7. What are you looking for in a program?
8. Why do you like this program?
10. Tell me about an interesting case you saw.
11. How have you directly impacted the care or management of a patient?
12. Tell me about the research you've done. (If you've done research, know every aspect of it front and back because they will for sure ask you about it)


Interview outfit. Honestly people, it doesn't matter that much as long as it fits you, you're clean/neat, and professional. Ladies, you do not need to wear a suit. I wore a knee length dress and blazer for all my interviews. I had a fitted blue dress I wore with a grey blazer, and a black dress I wore with a brown blazer. I wore pointy toed heels (which I was told was a huge no), but you know what? I got so many compliments on my interview outfit from program directors, fellow interviewees and my interviewers. Do not look slutty under any circumstances. High necklines and knee length skirts and dresses!  Guys, you guys have to wear your suits, I'm sorry. But again, make sure if actually fits you, and it's clean. Blue, black, pinstripes, its all fine. Wear a slightly exciting tie if you want a conversation piece, it's not going to hurt you as long as it's not outrageous. But honestly, people are superficial beings and if you look good, you're already winning points without even opening your mouth.

Always be on time. Always. Over prepare if you have to.

Be nice, courteous, polite to every single person you encounter. Be friendly to the secretaries, the coordinator, the janitors, the kitchen ladies, the other interviewees, the residents etc. Everyone knows each other and one bad word about you from any of them, you bet you will be eliminated from that rank order list. Program directors will often times ask residents, the coordinator, others for feedback about your personality and behavior throughout the day.

If you go to resident dinners the night before, its okay to have a drink. Maybe even a second drink, but nothing more. This goes without saying but don't get drunk. You're there to get a sense of the program and what it would be like to be working/having fun with these folks for the next 3+ years of your life.

Be excited for god's sake. You're interviewing at an awesome program. Be happy! Be curious! Smile. Positive vibes can easily be picked up and people respond favorably.  

Write a thank you card to the program director or send a thank you email. I tried to do this with everyone I met with, but it gets hard. For my child neuro interviews, I'd meet with 8 or so attendings between pediatrics and neuro. Eventually I just started emailing the program director or any interviewers who I had a particularly good connection with. 

If you are worried about the number of interviews you are getting or you haven't heard from a particular program you really like, EMAIL THEM if they have not already rejected you. It cannot hurt you, only help. Email the coordinator or director and ask for an interview because you love that program for X, Y, and Z and think it would be a worthwhile interview for all parties involved. They may kindly decline you, ignore you, or maybe just go ahead and give you that interview. I recommend waiting till about early-December to do this. If you go too late, there may not be any interview days left, but you don't want to ask too early either. Many programs try to offer interviews to people who they want and believe will actually come to their program. Nowadays, it's so easy for applicants to just hit a check box to any program without any real consideration of going there.


That's all I got for now. Good luck everyone! If you're at UT, drop a line.

Benji had some tips he posted last year regarding the interview process, which I agree with--> Check it out here

The Quick and Dirty Guide to Breastfeeding: What a Resident Should Know

Why encourage breastfeeding?

1. It’s personally cheap, no need to spend all that $$$ on formula

2. Breastfeeding is associated with a lower incidence of obesity.

3. Breast milk confers extra immunologic protection through a variety of immunogenic proteins, immunoglobulins, and oligosaccharides, THUS…

 Breastfeeding has been associated with a decreased risk of otitis media, diarrhea, lower respiratory tract hospitalizations, hospitalizations in general, and deaths, including death from SIDS, which also means…

à It’s cheap for society!!!  Significant public health savings!

What’s in breast milk (and how is it different from cow’s milk formula)?

Colostrum, secreted in the first several days of life is particularly high in secretory IgA.  Transitional (3-4 days of life) and mature (2-4 weeks) human milk, however have higher protein, fat, and lactose content. Mature human milk contains 70% whey protein to 30% casein protein (vs. 18% whey to 82% casein in formula) for easy digestion, 20% non-protein nitrogen including nucleotides (vs. 5% and ZERO nucleotides in formula), and predominately long chain fatty acids including DHA (vs. predominately medium chain fatty acids in formula).  Both have lactose as the major carbohydrate.

How long and how often should infants’ breastfeed?

Most infants feed for 10 to 15 minutes per breast, with some initially feeding up to 30 minutes on each side every 2 to 3 hours.  Be sure to let mom know that she needs to empty one breast before starting on the next because milk closest to the nipple is called FOREMILK and has a higher water and protein content compared to the HINDMILK which has higher caloric and fat content.  Once baby stops feeding, make sure to have mom begin the next feed on the side she ended with (keeps things even)

Signs of successful breastfeeding:

The baby is making swallowing sounds, is satisfied after feeds and is alerting every 2-3 hours to be fed. Infants should regain their birth weight by 2-3 weeks of age and gain 20-35 grams per day thereafter.

If that doesn’t happen, consider…

A poor latch. It will lead to nipple pain, poor transfer of milk, prolonged feeding, and an unsatisfied baby with poor weight gain.  Infrequent bowel movements can be a sign that there is insufficient milk intake.  Discomfort with initial latch is common but pain should not persist through nursing.  If possible, observe the infant nurse while in the office, and check if the areola is in the infant’s mouth. If the latch is observed to be good, then attention should turn to the mother’s milk supply.

And how about that milk supply?

Mother’s should begin breastfeeding ASAP because prolactin levels may diminish after as little as 16-24 hours without nursing after birth. Colostrum, rich in IgA antibodies, is the first fluid produced in lactating mothers and the volume is quite small  (5-15 mL/feed), which encourages frequent feeds and increased milk production. Milk production begins 1-5 days (average 3 days) after birth and production is determined by supply and demand. The more often mom breastfeeds/pumps and empties her supply, the more often milk will be produced.

Who may have difficulty breastfeeding?

 Not women with small breasts, not women with large breast, not even women with fake breasts, but possibly for women with a history of breast reduction depending on whether the main ducts were severed during the procedure, women with flat or inverted nipples, or women with no change in breast size during pregnancy.

What supplements are needed for the newborns who are exclusively breastfed?

1.     Vitamin D! AAP recommends infants take 400 IU daily.

2.     IRON, man: 1mg/kg/day of elemental iron is recommended for exclusively breastfed infants over 4 months of age (those not taking iron containing foods)

Which commonly used antibiotic causes mom to temporarily stop breastfeeding?

Metronidazole. It is an in vitro mutagen and it is recommended mom discontinue breastfeeding for 12-24 hours if a single-dose therapy is given.

To check for other medication interactions with breast milk, please visit LACTMED

è http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT)

How about that alcohol and caffeine?

Breastfeeding mothers aren’t recommended to consume alcohol when breastfeeding but on occasion they may have one alcoholic beverage, but must wait 2 hours before resumption of breastfeeding.  As for coffee, moderate levels of caffeine have not shown to be harmful to nursing infants.

What is the AAP’s recommendation on the minimum duration for exclusive breastfeeding?

The AAP recommends a minimum of 6 months of exclusive breastfeeding.  After that age, infants should be supplemented with complementary foods that are rich in iron and screened for the need for fluoride supplements.

Breast Milk Storage:

Room Temperature – 6-8 hours (3-4 in a warm climate)

Back of the fridge – 5 days

Freezer compartment- 2 weeks

Regular Freezer with its own door- 3-6 months

Deep Freeze – 6-12 months

First Day as a Working Doctor

The long white coat

July 1st. The start of a new chapter. The unofficial day that all new interns start working and realizing their dreams as doctors. Also the day we realize how little we know. I'm already a week into work since my program started us on June 24th. It was a nerve-wrecking couple of days just learning the computer system and where everything is and what's expected, but so far so good. Luckily, I'm starting with an elective for chronic care and palliative services at Children's Memorial Hermann Hospital. It still hasn't sunk in that this is real yet. I still feel like a med student.

Ever Wonder How Residency Programs Rank Against Each Other? Meet Doximity

For the first time this match season, thousands of interviewing 4th year medical students had the opportunity to use Doximity's Residency Ranker before submitting their final rank lists. Released September 2014, Doximity opened its Residency Navigator tool to the medical world allowing anyone to see how each residency programed stacked up against others. There has never been a unified location where residency programs are examined and ranked on a list... until now. Using more than 50,000 physician evaluations of the 3,691 training programs in the US, Doximity has been able to provide more transparency in the performance and quality of training programs in 20 specialties. Unfortunately child neurology was not included in this year's rankings, but perhaps it will make an appearance when they release the new rankings in August 2015.

Anyone can see the top 10 residency programs in each specialty, but to get the full list you must register (for free) to Doximity.

Residency Ranker--> Here

List of Pediatric Programs that are Caribbean (IMG) Friendly

*Updated March 2016*

I know in my last post I went into the difficulty Caribbean med students have at getting interviews-- for every interview offer we receive, we tend to get 10-15 rejections. Within every specialty, you have the set number of hospitals who are historially IMG friendly and many Caribbean applicants will be getting many of the same interviews at these institutions, however people still can secure a couple more interviews at less IMG friendly programs that are intrigued enough to offer an interview. Factors that can lead to these interviews include: board scores that can't be ignored,"home field advantage" (if you are originally from the area of the program), or you know someone/ have a connection.

While going through the match lists from AUC, St. Geroge's, Ross, etc I pulled out the most IMG friendly pediatric programs that people from all these institutions were interviewing at. Aside from a few impressive matches for SGU pediatric hopefuls, most of the other Caribbean med schools had the same matches.

 I didn't see any real outliers. There's always exceptions of course, but the vast majority of programs were the same across the board. Hence this makes me think that people interested in pediatrics will be able to save a ton of $$$$ on applications by just knowing which programs to apply to. Without further ado, here's a list!

Interviews I Got: hence, I know for a fact these are Caribbean friendly

-John Stroger Hospital of Cook County Program (Chicago, IL)
-Hurley Medical Center/ Michigan State University Program (Flint, MI)
-Western Michigan University School of Medicine Program (Kalamazoo, MI)
-Atlantic Health Program (Morristown, NJ)
-Jersey Shore University Medical Center Program (Neptune, NJ)
-St. Peter's University Hospital Program (New Brunswick, NJ)
-Albany Medical Center Program (Albany, NY)
-Bronx-Lebanon Hospital Center Program (Bronx, NY)
-Nassau University Medical Center Program (East Meadow, NY)
-New York Methodist Hospital Program (Brooklyn, NY)
-Richmond University Medical Center Program (Staten Island, New York)
-SUNY Health Science Center at Brooklyn Program (Brooklyn, NY)
-SUNY at Stony Brook Program (Stony Brook, NY)
-St. Barnabas Hospital Program (Bronx, NY)
-Staten Island University Hospital Program (Staten Island, New York)
-University at Buffalo Program (Buffalo, NY)
-Case Western Reserve University (MetroHealth) Program (Cleveland, OH)
-Marshfield Clinic- St. Joseph's Hospital Program (Marshfield, WI)

Other Pediatric Programs Caribbean Students Matched At (taken from AUC, AUA, Saba, Ross, St. George's, and St. Matthew's match lists)

-University of California (San Francisco)/Fresno Program (San Francisco, CA)
-Florida Hospital Medical Center Program (Orlando, FL)
-University of Florida College of Medicine Jacksonville Program (Jacksonville, FL)
-Mount Sinai Hospital Medical Center of Chicago Program (Chicago, IL)
-Advocate Lutheran General Hospital Program (Park Ridge, IL)
-University of Illinois College of Medicine at Peoria Program (Peoria, IL) 
-Louisiana State University Health Science Center -Shrevport Program (Shrevport, LA)
-Our Lady of the Lake Program (Baton Rouge, LA)
-Sinai Hospital of Baltimore Program (Baltimore, MD)
-St. John Hospital and Medical Center Program (Detroit, MI)
-Children's Hospital of Michigan Program (Detroit, MI)
-William Beaumont Hospital Program (Royal Oak, MI)
-University of Mississippi Medical Center Program (Jackson, MS)
-University of Missouri Program (Columbia, MO)
-Cooper Univ Hospital Program/Cooper Medical School of Rowan Univ(Camden, NJ)
-Rutgers New Jersey Medical School Program (Newark, NJ)
-St Joseph's Regional Medical Center Program/ New York Medical College (Patterson, NJ)  
-Brooklyn Hospital Center Program (Brooklyn, NY)
-Flushing Hospital Medical Center Program (Flushing, NY)
-Harlem Hospital Center Program (Harlem, NY)
-Lincoln Medical and Mental Health Center Program (Bronx, NY)
-Maimonides Medical Center/Infants and Children's Hospital of Brooklyn Program (Brooklyn, NY)
-SUNY Upstate Medical University Program (Syracuse, NY)
-Winthrop University Hospital Program (Mineola, NY)
-Cleveland Clinic Foundation (Cleveland, OH)
-University of Oklahoma College of Medicine -Tulsa Program (Tulsa, OK)
-Albert Einstein Healthcare Network Program (Philadelphia, PA)
-Crozer-Chester Medical Center (Upland, PA)
-Geisinger Health System Program (Danville, PA)
-East Tennessee State University Program (Mountain Home, TN)
-University of Tennessee College of Medicine at Chattanooga Program (Chattanooga, TN)
-Driscoll Children's Hospital Program (Corpus Christie, TX)
-Texas Tech University Health Sciences Center Paul L. Foster School of Med  (El Paso, TX)
-Texas Tech University (Amarillo) Program (Amarillo, TX)
-Texas Tech University (Lubbock) Program (Lubbock, TX)


This list is not exhaustive. It's 53 IMG-friendly programs out of the 210 total pediatric residencies in the United States. There are a couple of outlier programs I saw on the SGU pediatrics match that don't traditionally like IMGs (Children's at Univ of Miami, Rainbow Babies in Cleveland or WashU in St. Louis), so I figure there were other factors at play, so I left them off the list above. Anyway...apply to the programs above and any programs in your general geographic region. Otherwise, especially with many of the big name institutions (Never apply to Yale or Boston Children's or CHOP, they throw out IMGs automatically), don't waste your money applying to them unless you have some sort of connection or outstanding board scores (peds= 240+). 

How Caribbean students do in the match (from my personal experience)

I think the big question people have when looking into Caribbean medical schools is whether or not they can get the residency they want. Or maybe the big question is *if* they can even get a residency. The answer is yes. The official stats haven't come out yet for AUC, but based on the highly accurate facebook posts and word of mouth news, the great majority of my classmates matched. Naturally we don't tend to match into the ultra competitive fields of plastic surgery, orthopedic surgery, neurosurgery, otolaryngology, dermatology, or ophthalmology (actually we had one person match in optho this year) but we have a good number of people matching into internal medicine, pediatrics, family medicine, OB/GYN, general surgery, psychiatry, radiology, anesthesiology, pathology, emergency medicine, and PM&R. And people not only match in their desired specialty, but the majority match into one of their top 3 choices.

With all that being said, however, I'm not going to lie to you... coming out of the Caribbean is tough during interview season. It will be used against you. You won't get interviews at many places just because you come from a Caribbean med school. I know excellent students with amazing board scores, high class rank, all honors in clerkships, and what's the result? They still get pigeon-holed into the same programs that are IMG friendly and are unceremoniously ignored by the majority of other programs. Even when they can get interviews at well-known and respected institutions, more often than not, they will be ranked lower than their US grad counterparts. It's not fair, but that's just the way it is.

I'm going to take myself as an example. I applied to both child neurology and pediatrics. I was a competitive enough applicant in my chosen fields.

My stats:
224 for Step 1 (first attempt)
226 for Step 2 (first attempt)
Passed CS (first attempt)
In the top 1/3 of my med school class
Numerous community service experience
Held a leadership position
Received an "Outstanding" recommendation in my MSPE letter
Had 3 strong letters of recommendation (2 of which were from Massachusetts General Hospital).

The results:
Out of the 49 child neurology programs I applied to, I was offered 12 interviews.
Of the 123 pediatrics programs I applied to, I was offered 19 interviews.

As sad as this may sound, coming from a Caribbean medical school, I did well for myself. To anyone else outside of the Caribbean system, those are some tough numbers to swallow.  Hell yes this was expensive, but the more you spend on applications, the higher your odds of getting an interview, and the higher your odds of matching. So that is why Caribbean medical schools encourage their students to apply to as many programs as they can afford.  If you are considering Caribbean, definitely know this before coming in.
  

A Little about Child Neurology

I’ve been getting a lot of questions from people regarding child neurology. It’s not a well-known specialty; it’s barely discussed in medical school, and there’s little to no opportunity to do rotations in it. I believe at AUC specifically, we only have one green book rotation option at the University of Florida in Gainesville, in which special permission is needed from a faculty member to even rotate there.  With so little exposure, it’s no wonder why so few students know about it.  

So what is child neurology? What do child neurologists do? What sort of cases do they see? 

Child neurologists take care of children with any sort of neurological condition.  It’s mostly an outpatient specialty where the bread and butter cases include AD/HD, Tourette’s (tics), epilepsy, autism, headache, and cerebral palsy. A great deal of the time, child neurologists examine and work up patients who are referred for questions in developmental delay of speech, fine/gross motor skills, social skills or learning disabilities. Other pathologies child neurologists see are children with genetic disorders such as Angelman’s, Down, Fragile X, Tuberos Sclerosis Complex, among others and on rarer occasion children with brain cancer, muscular dystrophies, and mitochondrial disorders. I personally have an interest in concussions, chronic traumatic encephalopathy, and traumatic brain injury within the pediatric population, so we’ll see how well my training deals with those issues.

Although much of child neurology is centered in outpatient clinics, there are a huge number of child neurologists who work in the inpatient setting. Getting consulted to the NICU for newborns with floppiness or brain injuries (i.e. intraventricular hemorrhage), performing lumbar punctures, overseeing the epilepsy monitoring unit, reading EEGs, getting called to the ER for patients with question of seizure, cases of status epilepticus, etc.

If any of this sounds interesting to you, then maybe a career in child neurology is something you should consider.

How to apply to child neurology?

Child neurology used to be part of the Philadelphia Match, and it only just recently joined the main NRMP match (it’s in its third year). Like adult neurology, you can match into pediatric neurology directly. There is no fellowship necessary after doing 3 years of pediatrics, although you can do child neurology after doing the 3 years of pediatrics.

Child neurology is a small world. There are only 72 programs in the United States with the majority being university-based at major teaching institutions. You can enter a program as either a categorical, advanced, or reserved resident. Historically, most doctors entering child neurology would do 2 years of pediatrics and leave before their third year to enter a 3-year child neurology program. The problem with this of course, is that most pediatric residency programs aren’t thrilled about losing a resident for the third and final year of residency. Of recent years, most programs now offer a combined pediatrics/child neurology 5 year categorical residency program where you spend all 5 years training at the same institution. You do 2 years of pediatrics like any other pediatric resident (a few elective blocks are swapped for inpatient blocks), and then you move on to neurology for the final 3 years. By the end of the 5 years you can be double boarded in both pediatrics, as well as for neurology with “special qualifications in child neurology”.  Although most residents opt to only take the child neurology boards since most never practice general pediatrics.

When I applied this past year, I only applied for categorical positions.  I did end up applying to pediatrics as a back up but had I matched into a pediatrics residency position, I’m not entirely sure I would have gone the neuro route.  I decided early on I would finish my full 3 years and re-assess where to go from there.

"Where Did I Match?"

My post title is the subject heading of the email everyone receives from NRMP. I had a mini panic attack when the email finally came at 1 pm, so I let my friend read me the results and it looks like I'm moving to Houston, Texas! I matched for the 5 year Child Neurology categorical program at UT- Houston!!!!!

The Texas Medical Center

The program at UT-Houston, as well as University of Virginia (UVA) and St. Louis University (SLU) ended up being my favorite programs that I interviewed at. I had a really tough time deciding how to arrange my rank order list hence the constant changes, but I was going to be ecstatic to match at any of my top 3.  Honestly, I could not be more thrilled about where I landed!!!! The Texas Medical Center (the largest medical center in the world) was the most impressive sight I saw on my interview trail. Over 20 hospitals, 8 research institutions, 50 health related colleges and universities in the medical, dental, pharm, and nursing fields. Anything that I could possibly want to do with my career as an M.D., I know I can accomplish by training here. 

Memorial Hermann (the two buildings in the foreground) will be my primary hospital site over the next 5 years. I also will spend some months at MD Anderson Cancer Institute and LBJ General Hospital (not shown).

I Matched!!

Yes, I found out Monday I matched. Yes, I find out tomorrow where, and I will be sure to update my blog for it! Just a celebratory drink post-work/post- run on Monday. Looking at your newest pediatric resident come July!

Countdown to Match

My rank order list has been submitted (deadline was Feb 25th), I've packed up my stuff and left New York City for good, roadtripped down to Miami, and now I'm on my final rotation of medical school at an outpatient pediatric neurology office in Hialeah. March 16th is the day we find out *if* we match, and the 20th is the day we find out *where* .

You may not be aware but I applied to both child neurology and pediatrics for this match cycle and I was lucky enough to get over 30 interviews. I went on 18 of those, and ended up ranking 16 programs-- 10 child neuro, and 6 pediatrics.

Two more weeks!