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Ch. 10 - Making the Most of Interview Day

Interview day gives you a firsthand look at the programs you have been researching. This is an important day for the programs as well, because your interview day score is highly important when ranking residents, outdone only by your SLOE letters.1 Make a good impression — and understand that it’s equally important for you to interview the program and determine how well it fits your needs and goals.

Preparing for Interviews

Interviews can be stressful, but adequate preparation leads to success. Practice answering interview questions with a friend. Think through ways in which you’ll describe yourself, your hobbies, and your reason for choosing EM. Plan specific questions for each program. This will allow for a more natural conversation, and you won’t have to do all the talking!

Most important, be yourself on interview day. You have made it this far in your career, so you’re clearly a bright, intelligent, and successful individual. Even if you are on the shy side, remember that you know yourself better than anyone else, and the interview is the time to let your positive qualities shine. Residency interviews help the program faculty and residents get to know you as a person, and they also help you decide if the program is a good fit for you.

Scoping Out the Area

When traveling to a city or region that is new to you, explore the area. Finding a location where you will be happy spending your free time is important to your future wellness. The pre-interview events are also a great opportunity to find out more about the area.

When evaluating a new area, consider what is important to you. Would you prefer to live in a house with a yard, a condominium, or an apartment? This is determined not only by the region (a house with a yard may be less obtainable in a larger, urban setting), but also by your personal needs (family, children, pets) and the prospective duration you might be there (3- or 4-year program, fellowship, employment goals). You also need to think about which of these choices is affordable on your income. Resident salaries are fairly consistent across the nation — unlike cost of living, which varies dramatically. Finding out where the residents and staff live can be very helpful.

In addition to housing options, learn what there is to do in the area. Are there local parks? How varied are the dining and entertainment choices, and are they affordable? Where do the residents go to unwind? If you have children, you’ll want to know how the schools rank, are they close by, and — if you’re evaluating private schools — whether they’re affordable. What amenities and activities does the area have for children? If you have a significant other, it might be beneficial to have them scope out the area during your interview, especially if time is an issue. If you find yourself more
impressed than expected by a program or its location, consider coming back for another visit before submitting a rank order.

Interview season should be fun. Do your research and prepare, but don’t forget to be yourself. This is your chance to find the program that is the best fit for you.

As you’re planning your visit, research the hotels near your interview site. Often, the closer the better, although many hospitals with thriving EDs are located in areas that can be less desirable, so be safe. Keep in mind that the area around the medical center may have a very different atmosphere than the surrounding city, so make sure to explore the city before making a final impression, and don’t necessarily base your impression on that single location. Additionally, a handful of programs offer on-site lodging, and will usually inform you of this. It has become increasingly common for residents to invite interviewees to stay with them, giving you a window into the resident lifestyle in that area.

Pre-Interview Events

Most programs will host an event to allow current residents and faculty to meet candidates in a more casual setting before or after the formal interview. This event is primarily for your benefit. Some newer programs may not have enough residents yet, so you’ll get a chance to speak with the  aculty informally. Occasionally travel plans and other interview schedules may interfere with your attendance at these events, but try not to miss them. The more direct “face time” spent at a program, the greater the potential benefit for you and the program; applicants have ranked “personal experience with residents” as one of the most important factors when making a rank list.2 Consumption of alcohol is generally accepted in moderation at social events — but remember every interaction with a program is an extension of the interview day, and residents will likely report back to their administrators about any concerning behavior. If the social is scheduled for the evening prior to your interview, keep in mind you have a busy day scheduled for the next morning, and most interview days begin early.

Interview Day Routine

The less rushed you are in the morning, the more relaxed you will be. Give yourself plenty of time to get dressed, pack your bags, and head to the interview. Ideally, checkout from your lodging should be later in the day or the following day, giving you time to explore, or at least change and pick up your bags. However, this may be impractical in terms of cost and travel plans, in which case you’ll need to factor checkout time into your schedule. Most programs can keep your bags safe for you during your interview day, although space may be limited.

Military Match: The military uniform for interviews is important. Make sure to discuss this with upperclassmen/classmates or reach out to a mentor.

Arrive a little early, giving yourself a window for any delays (getting lost, traffic, parking). Although most programs are reasonably understanding of delays, being late gets you off on the wrong foot. The food and breakfast options provided by a program on interview morning may vary significantly (full meals to very little), so grab a meal before you arrive if time permits, or plan on bringing something with you, just in case. Be careful with the morning coffee if you are nervous, as your heart rate might not need the extra caffeine boost.

Do Your Research

One of the best ways to put yourself at ease and impress your interviewers is to do your research beforehand. Be sure you have reviewed the program’s website and other readily available information.

  1. Know the program leadership — particularly the chair, program director, assistant/associate program directors, clerkship director, and chief residents, as well as the program coordinator. This can help you tailor your questions to the individual who may answer them most effectively. You can reach out to the program coordinator ahead of time and ask who you will be interviewing with if you want to further investigate their particular interests.
  2. Review basic program demographics — class size, required off-service rotations, and secondary departments. You should come to every interview with questions written down that are important to you. Don’t ask questions easily answered by visiting the program’s website.

Take Notes

Interview season can be a long road, and by the end, some of the important program details and your memories of them will begin to blur. Notes on who you met, whom you interviewed with, the questions you asked, and the answers to those questions, or general conversations with key members of the program will be an important reference when the time comes to make your rank list. It will also be useful if you need to reply to the program and its members.

The Interview

The interview day generally begins with an overview of the program, typically delivered by the PD. This will answer many questions, though the focus usually will be on the strengths of the training experience. A tour of the ED and other parts of the hospital are also typical components of the day.

The interviews themselves tend to be several separate short interviews, usually one-on-one, with members of the program leadership, faculty, and sometimes residents. Programs may have each interviewer focus on a different aspect of the applicant, such as academics, goals, or personality fit for the program. Don’t worry about who’s looking for what. Being yourself is more important than trying to cater your answers to what you think each interviewer wants to hear. Most emergency physicians tend to be relatively down-to-earth people who genuinely enjoy having a good, professional conversation with applicants. And remember it is a conversation; don’t be a passive participant simply reacting to questions. The interviewers are trying to get to know you, and they want to hear what you have to say.

Anything you have provided in your application is fair game for interview questions, so know your application. If you listed spear fishing as a hobby, you should be able to hold a conversation about it. (Your interviewer may be a spear fisherman too!) Also, keep in mind that a tangent is considerably different than a conversation. Keep your answers concise.

Couples Match: You are not required to discuss your couples match situation; there are potential risks and benefits of doing so — discuss this strategy with your partner and advisors. During your interviews, consider mentioning connections that you or your partner have to the area. If your partner liked their interview, consider mentioning this as well.

IMG Students: This is also an opportunity for you to demonstrate how your experiences at your home institution can contribute to your career.

At-Risk Candidates: If you are applying to another specialty as a back-up in parallel with your EM application, this will not be evident to reviewers or interviewers. You are under no obligation to divulge this.

Red Flags

The interview is an opportunity to explain any red flags in your application. At least one interviewer will ask you about it. Remember, if anything in your application was disqualifying, they would not have invited you for an interview. Avoid making excuses for everything you think is deficient in your application. It is only a chance to briefly explain a particular event that diverges from the rest of your application. Do not dwell on negativity; keep a positive attitude and remember there is something to be learned from every negative event, and strength in recovering from such.

At-Risk Candidates: If your application has any red flags, such as failure of the USMLE, pre-clinical course or clerkship, a prior felony or misdemeanor history, or extended time in medical school, be prepared to address these topics in the interview. As in the personal statement, take  responsibility, don’t make excuses, and most important, articulate how you have emerged from these challenges better prepared for a career in EM. Practice answering red flag questions out loud with a friend or advisor.


Finally, remember during the interview that you are also interviewing the program. You need to find out if this is the right place for you to spend the next 3–4 years. You should be prepared with questions about characteristics of the program that are important to you. Ask more than one member of the program, as they may have different perspectives on the issue. Also, some potentially important details may not be clear from the website or general program overview presentation (eg, clinical and didactic teaching styles, program goals for the future, recent changes made to the program structure, resident wellness, resident retention and remediation, and changes in staffing). Do not be afraid to ask for contact information for current residents or graduates from their program. There is no better way to assess a program than by talking to someone who has been there.

Additional Observations

At the end of the interview day, you may be tempted to grab your things and go. However, this is often a wonderful time to ask if you can stay a little longer, taking time to observe how the department flows. Most programs are happy to have interviewees spend time in the ED as an observer. Viewing the interactions on-shift can give you a lot of insight. Do the physicians seem happy? Does the team appear cohesive? What kind of patient load is each resident carrying at each stage of their training? Are there pleasant interactions between the ED and their consultants? Introduce yourself to anyone and everyone, and ask if you can tag along. You can even consider traveling with an extra pair of scrubs. Again, make notes on this portion of the visit.

The Second Look

The second look is another way to gain additional insight into a program, especially when having difficulty with making the top of your rank list. Second looks can be a considerable added expense and are not expected. Revisiting every program where you interviewed is completely unnecessary; secondlook trips are only beneficial if you are having difficulty choosing between 2–3 programs.

Second visits are usually easily obtained by calling or emailing the program coordinators. Usual attire is clinical, including badge and white coat, rather than business attire. Second looks should be focused on visiting the clinical areas rather than meeting with program directors again. You are there to get a better idea of how and if you fit into the day-to-day interactions at that program. Residency programs typically avoid initiating any further formal contact after your interview, as that would potentially violate NRMP rules. Do not be offended if the program director or administrative staff do not meet with you formally.

Thank-You Notes and Further Communication

It is common courtesy to thank your interviewers for their time; however, the overall value of the thank-you note varies greatly among program leaders. Generally, an email is just as acceptable as a handwritten letter, although there is likely some variation in this belief. There is no rule on the timing of the note, but it is best to send it immediately after the interview, before it moves too far down your to-do list. Sending a note is unlikely to significantly change the way a program ranks you, although it cannot hurt, and is a common professional courtesy that will be noticed as your career continues. 

After interviews you will be faced with a decision on communicating with programs regarding where they stand on your rank list. This is a muchdebated subject without a clear answer. It is very important to note that you are not required to divulge a program’s rank order, even if directly asked by any member of the program. In fact, NRMP guidelines specifically state “program directors shall not solicit or require post-interview communication from applicants, nor shall program directors engage in post-interview communication that is disingenuous for the purpose of influencing applicants’ ranking preferences.”3 This guideline is interpreted differently by each program. Some take a hard line and completely abstain from any initiation of contact with applicants. Others may feel that notifying their highly ranked applicants regarding their status is not “soliciting” or “disingenuous.” And some programs will initiate a discussion of the applicants rank list despite these guidelines.

Be diplomatic yet honest in all post-interview communication. Don’t read too much into any program’s response (or lack thereof), due to NRMP restrictions.

In terms of actual practice, in a study of the 2006–2007 EM interview cycle, 90% of respondents reported being contacted by a program between their interview date and rank list submission, with the majority via email.4 Three out of 5 contacted were happy about the information, but 1 out of 5 reported feeling uncomfortable, likely due to the nature of the contact.

Data with similar results have been published based on non-EM specific research. Additionally, it was noted that almost 25% of respondents altered their rank order based on post-interview communication — and 20% of respondents reported feeling assured they would match at a program, but did not despite ranking that program first.5 Another study published in 2009 found that 8% of respondents were specifically asked to divulge a program’s rank position by a program representative, and almost 7% reported matching at a program that was lower on their rank list than a program that informed them they were “ranked to match.”6

You are not compelled to divulge rank order information to programs, and programs should not be asking. Likewise, you should not rely on information a program gives you about your order on their rank list. However, the NRMP does not stipulate guidelines for applicants regarding post-interview communication. You may freely disclose to a program where it is ranked on your list — but be honest. The most common practice is to notify your top-ranked program of its position. A program’s response to such information will vary greatly, from no response, to a purposely vague response, all the way to a definite answer of your ranking by them. Do not read too much into any response (or lack of response); each program takes a unique approach to complying with NRMP rules.

The Bottom Line

  • Interview season should be fun. Do your research and prepare, but don’t forget to be yourself. In addition to the program trying to decide if you’re the right fit for them, this is your opportunity to figure out if the program is the best fit for you.
  • Take advantage of pre-interview events to get to know the current residents. They are the ones most likely to give you an unbiased view of what it’s like to train at the program. If consuming alcohol, do so in moderation; you’ve got a big day ahead of you!
  • Be sure to take plenty of notes to help you make ranking decisions between programs.
  • Do not spend too much time worrying about thank-you notes. There are no rules, and it’s unlikely to significantly change the way a program ranks you; however, it can’t hurt, and it’s a common professional courtesy.
  • Do not play games with any post-interview communication (ie, don’t tell every program they’re your No. 1 program); it’s a small world and it could be very awkward the next time you see a PD to whom you sent a disingenuous message.
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