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ANATOMY OF A RESIDENCY INTERVIEW
By
Jay
Lieberman, DPM
The East CRIP interviews are held in an Embassy Suites Hotel
near the airport in Philadelphia. As you enter the hotel, there
is a large atrium which affords you a view of the catwalks that
are immediately outside the rooms. The hotel is about eight
stories tall. Outside every sixth or seventh room stands a well
dressed applicant waiting for his or her turn to be interviewed.
Without knowing about the interview process, this sight would
appear quite bizarre, like something out of A Brave New World.
As hard as everyone tries to seem relaxed, the atmosphere is
tense and the anxiety level is high. Many of the applicants have
only one appropriate outfit. One stain or one tear and it’s all
over. I recall seeing one of our applicants waiting in the
hallway using Lehninger's Biochemistry to cram just a few
minutes before his interview. What could he have been thinking
!?
Our interview committee usually brings ten or so cases, complete
with x rays, blood work, reports and a summary. We try to ask
questions that will test the applicant’s ability to work up a
case, rather than posing questions that have one word answers.
We also present social and ethical issues for discussion.
There is one standard question that we ask each and every year.
We have probably worn it out so I will present it here:
You are a first year resident scrubbed in on an Austin
Bunionectomy being performed on a twenty one year old athlete.
The attending physician allowed you to play a large role in the
procedure. Just prior to closure, the attending points out an
iatrogenic laceration of the Extensor Hallucis Longus Tendon. A
primary repair is performed. The wound is closed and a below the
knee cast is applied. Just before leaving the hospital, your
attending requests that you make no mention of the untoward
event in the operative report. Once he leaves the hospital, he
will be unavailable for three days. He has instructed you to
review the post operative instructions with the patient. The
patient immediately notices the cast which was unexpected and
inquires why it was necessary. In fact, the patient goes as far
as asking if anything went wrong.
a. What is your reply to the patient?
b. If you had the opportunity to say anything to your attending
prior to his departure, what would you say?
Many students are aware that a question like this is commonly
asked, yet the variety of answers is astounding. I would be
interested to know all of your thoughts as to whether you think
this question is appropriate and/or effective in gauging the
character of a resident candidate.
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EDITOR
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RESIDENCY INSIGHT
Jay Lieberman seems to have hit a nerve with his
provocative ethics based residency interview question,
and received many responses with varying opinions.
Some think residency applicants shouldn't be put on
the spot, while others feel that is exactly the point and
the goal of the interview process. Are our needs best
met by "testing their mettle" or by keeping the interview
cordial ? Read on...
Alan Sherman, D.P.M.
Editor - Podiatry Online, Inc.
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RESIDENCY INSIGHT
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RESIDENCY INTERVIEW QUESTION
PROVOKES STRONG RESPONSE
FROM THE PROFESSION
By Jay Lieberman, DPM
drjayl@prodigy.net
Director of Podiatric Education
Northwest Medical Center
Margate, Florida
To all those who responded to my proposed residency interview
question seeking to test the moral fiber of an applicant, I
offer the following response: I understand your concern regarding
the possibility of an impressionable resident coming into
contact with an attending who displays immoral and unethical
behavior. I agree wholeheartedly that a physician like that
should be chastised through whatever means are available at the
particular institution and his/her contact with residents in the
future should be strictly limited or discontinued all together.
The question that I posed is designed to elicit a response from
a prospective resident that would give the interviewer some
insight into the ability of the individual to resolve a
conflict.
Hopefully, a resident at your
institution will never come into contact with a character like
the one described in the vignette. However, he/she is likely to
be confronted with some situation that poses an ethical dilemma
involving an or individual who behaves in a less than exemplary
manner. I contend that an open-ended question that reveals how a
candidate would resolve a problem or handle a situation is a
worthwhile question. Although this was an extreme example, some
interview questions should be designed to reveal a glimpse into
the integrity, honesty, and interpersonal problem solving skills
that the candidate possesses.
I have included many of the letters that I received below, so
that you can see how others felt about this issue.
Jay Lieberman, DPM
Director of Podiatric Education
Northwest Medical Center
Margate, Florida
drjayl@prodigy.net
_____________________
From: Barry Mullen, DPM
Subject: Residency Interview Question
The question Dr. Lieberman poses is absolutely appropriate to
ask of any prospective residency candidate, medical student
applicant or existing health care provider. I congratulate him
for creating a plausible scenario that raises questions
surrounding a candidate's integrity. In my humble opinion,
adherence to medical ethics supercedes ALL other health care
parameters. The Hippocratic oath is quite explicit regarding
honesty and integrity surrounding one's provision of health
care. The provision of health care is a privilege (we apply for
hospital privileges), one that unfortunately, is sometimes
abused. Though we all raised our right hands when we took the
Hippocratic oath at our podiatric graduation ceremonies, I
sometimes wonder how many of us truly realize the magnitude of
what we swore to abide to?! For these reasons, I became our
group practice's health care compliance officer.
From my perspective, the answer to the posed question is quite
simple and not subject to debate. The resident must be honest in
his/her description of the events that take place with respect
to any aspect of health care provision. As far as what I would
tell an attending who requested that I attempt to conceal the
facts surrounding an error: I would indicate that the act of
concealment breaches one's medical ethics and violates the
patient's health care rights. This is an issue that CANNOT be
condoned. I would personally voice my disgust to the attending
regarding the notion of concealment. I would demand an apology
for any attempted coercion whose effect placed me in a position
of compromise. I would not allow myself into an operating room
with him/her again until the matter was reviewed by the
residency program director, who should be immediately apprised
of the facts surrounding the events. It then becomes a peer
review issue open to debate to determine whether any
disciplinary action should be undertaken against the attending.
Attendings are teachers. Is this what we want our podiatric
children to learn and aspire to become?! To lie, to be deceitful
in our dealings and relationships with patients? The trust a
health care provider projects to a patient is THE most important
factor determining the strength of the bond forming the
physician-patient relationship. Personally, if I had my way, I
would ban this attending from performing cases in that OR, or at
least place him/her on some form of probation to protect the
residents and the hospital's interests until such time that this
attending demonstrates a change in attitude regarding his/her
ethical conduct.
How am I so sure of my response? Because I lived through and
responded in kind to a similar circumstance during my own
residency 20 years ago. While I may have scrubbed a few less
cases after being "blackballed" by this particular
attending (who
was quite active at our hospital), my word remained my worth and
my integrity was never compromised. To my residency program
director's credit, he supported my decision. I never scrubbed
another case with that attending. The lesson is simple, but
quite powerful: ALWAYS take the high road! This shouldn't just
apply to the practice of medicine, this should apply to all
aspects of one's life!
Barry Mullen, DPM
Hackettsown, NJ
YAZY630@aol.com
_________________
From: Barry Meskin, DPM
Subject: Residency Interview Question
The Doctor who requests his resident to NOT disclose such
iatrogenic laceration, certainly should NOT be a residency
attending. He should really be reported and removed from that
position.
In other words; the resident should tell the TRUTH, the WHOLE
TRUTH and nothing BUT THE TRUTH. No reasonable physician would
expect that from a resident.
What a ridiculous question to expect from residents. It is a
childish and immature question !!! However, I congratulate you
on opening such a discussion. I understand where you are coming
from. I did a PGY1 and PGY2 at CCPM. We unfortunately came
across some attendings that asked us to do some extremely
unethical, shameful and immoral things. I believe this is quite
common in the Podiatric residency world, sadly and
unfortunately.
Somehow I think we may need to standardize and interview some
attendings that we have assigned such privileges to "teach"
residents.
You would be shocked to actually hear some of the things that
were expected of us, even at such a "reputable" institution as
CCPM as recent as the 90's.
I would only hope that such debate will strive to IMPROVE and
CHANGE the current atmosphere, of ATTENDINGS VERSUS RESIDENTS.
If we look to our MD's in Surgery and Medicine, they fully
respect and truly "mentor" residents to a standard HIGHER than
themselves. Isn't that what education is all about ?I know first
hand, since I rotated at San Francisco General and Oakland
Highland with some of the leading educators in the world, and
FUTURE leaders in the world.
Barry Meskin, DPM
info@familyfeet.com
________________
From: Scott Schonfeld, DPM
Subject: Response to Your Entry "Anatomy of a Residency
Interview"
My name is Scott Schonfeld and I am a 3rd year Podiatry Resident
at St. Barnabas Hospital in the Bronx, NY. I am currently doing
a PSR-12. I recently visited Northwest Medical Center to see my
wife's Grandfather who is a snowbird residing in Margate for the
winter months and was recently hospitalized there. I was
impressed by your hospital. It was clean and new and the staff
was caring and helpful.
My first order of business is to tell you that I enjoy reading
your entries to Podiatry Online. I think they are informative
and very objective. I think that being part of a residency
program is an excellent way to give back to your profession
while keeping yourself constantly challenged and up to date on
the latest advances is Podiatry. I hope to be involved with a
residency program at some point in my career.
Secondly, I am writing to you in response to the question you
posed regarding gauging character of a prospective resident
during an interview. I have been on both sides of the fence in
the interview process. Three years ago I was one of those
nervous people you talked about walking around with sheets of
paper trying to squeeze that last fact into my brain before
entering the hotel room to be grilled. I did not like the
experience so I vowed that if I could make the experience any
better for the people to follow me I would make every effort to
do so.
Last year, as a 2nd year resident my attendings had invited me
along with a few other residents in my program to conduct
interviews. I saw this as the opportunity to do exactly what I
set out to do. But how would I do that? Well, the first thing I
did was to visit the radiology department in my hospital with a
list of interesting cases that I had encountered during my first
2 years at St. Barnabas. I think this is a pretty standard thing
to do because it seems like every other program does the same.
Next, I went through my Presby Residency guide to see what other
nit-picky things I could think of to ask. I thought this was
pretty good preparation to conduct interviews. So, on that Saturday
morning I went to the New York Weekend armed with my
arsenal of x-rays and questions and thought that I was going to
conduct the perfect interviews that every person was going to
enjoy and not be nervous. So, I gathered with my interviewing
team and we looked at the list of people that we were going to
interview. It turned out that most of the people on our list I
had already had experiences with through the externship process.
They had already known me from spending time at my program and I
had already known some of them. Also, I was not an attending so
I had thought that they would already feel a little more
comfortable. So, the clock turned 9am and we called the first
prospective resident into the room. The resident walked in all
nervous and shook all of our hands and made the appropriate
greetings. Then we sat down and a certain calm came over me. I
had realized that after all of the planning I had done I had no
idea what I was doing. Should I try to stump the person with one
of the nit-picking facts I had memorized that I probably didn't
know when I was on the other side of the table, should I do a
case work-up, or should I just try to be nice and conduct a
social interview? Well, we did a little bit of each and I
learned from each successive interview during the day how to
conduct the interviews. But, what I realized was that it didn't
matter what I asked on that day because I already knew about
each prospective resident from the time they spent at our
hospital. All of the numbers on their transcripts and the
recommendations that had been written on their behalf meant
nothing to me. I even chuckled after reading a few of the
letters of recommendations because they sounded exactly like the
letters that the same people had written on my behalf. Did it
really matter what answers the students gave us? I don't know.
But what I did know is that the best way to gauge a person's
character is to observe them over a period of time that is a
little longer than the allotted 15 minutes given by the people
who make up the schedule at the CRIPS.
I think that choosing a resident starts when they are a student.
More emphasis should be put on educating the students about your
program when they are Juniors in Podiatry School just before
they chose their externships for Senior Year. Tell them Junior
Year what you are looking for and see if they know their own
character well enough to see if they think they are what you are
looking for. If they think they are a match for you then they
should extern at your program and you can spend quality time
with them to see if they are a match before that nerve-wracking
15 minute interview.
It turns out that when I interviewed with St. Barnabas as a
student it was purely social. I had spent a month at the
hospital when I was a 4th year Podiatry Student and I knew the
program was a good fit for me and the Chief Resident that I had
interviewed me had known me and had thought the same. Right now
I am in my third year at St. Barnabas hoping to be chosen for a
fourth.
Lastly, going back to the question that you had asked regarding
the patient who's Austin Bunionectomy wound up with an
iatrogenic tendon laceration, I think it is a great question
that we can debate for many years to come. I think we all know
what the correct answer is to the question, but I think we all
know how we would answer it truthfully if we were faced with
that situation. Any answer can raise a question as to the
perspective resident's character thus defeating the purpose to
the question.
I hope my response to your question gave you food for thought.
Good luck with your interviews and I hope you match residents
who are a good fit for your program. Respectfully,
Scott Schonfeld, DPM
ScottSchonfeld@aol.com
____________
From: Marge Portela, DPM
Subject: Response to Your Entry "Anatomy of a Residency
Interview"
From my experience, I don't think it is a good question because
in the interview process, of course they are going to say that
they will tell the patient what happened and they say they will
not lie on the operative report, but in reality they would
probably listen to their attending and do as instructed. They
wouldn't want to be on the attending's bad side.
Margaret Portela, DPM
Mt. Sinai Hospital
Mportela_@hotmail.com
_____________
From: Dave Samuel, DPM
Subject: Response to Your Entry "Anatomy of a Residency
Interview"
Don't ask it. Typical podiatry question. I heard of it 14 years
ago when I was interviewing. My residents do as I say, and we do
things ethically at all times. Any attending that asks that of a
resident should not be allowed to work with them. He should
dictate his own op note, as I do with almost all of them. Don't
mess up these bright people with silly questions that has no
good answer. My thoughts (for the last 14 years)
Dave Samuel, DPM, FACFAS
desamuel@pol.net
_____________
From: Barry E. Lerner, DPM
Subject: Residency interview question
In response to your doubts as to whether your interview question
is effective and/or appropriate, I suggest it is neither, for
three reasons.
First, you have no business asking tricky questions to "gauge
the character" of anyone else, unless, of course, you completed
a full residency in psychiatry. And perhaps not even then.
Second, the candidate will of course tell you not what he would
do, but what he thinks you want to hear that he would do.
Third, even if you could magically look into the future and
observe your candidate's actual reaction to precisely the
situation you present, there would always be two opposite and
equally cogent arguments: one that he did the right thing, and
one that he did the wrong.
In your letter, you imply that although this particular question
may be retired, another similar one would be introduced. Pray do
not.
Fraternally,
Barry E. Lerner, DPM
bel34@earthlink.net
________________
From : Joel Gluck, DPM
Subject: Response to Your Entry "Anatomy of a Residency
Interview"
I read your article with interest from an educators standpoint.
As a professional educator (secondary and post-secondary science
and
gross anatomy), I find the case you described disturbing.
Although it does have a "correct" answer, the candidate is
forced to answer in a forced (perhaps even coerced) manner. This
is what is going on in the candidates mind:
Scenario 1: I listen to the attending. In this case it shows
that I have no backbone and I do not take the patient's best
interests seriously. I also lie to the patient and falsify the
medical record.
Scenario 2: I do the "right thing". In this case it shows that I
cannot follow directions, I am a young "whipersnapper" that will
not be a team player. I will piss off the attending, leave the
hospital open to a lawsuit, etc...
Either one of these scenarios are reasons for not taking a
resident. Who would want a student that cannot follow
directions, piss off his bosses, hurts the patient, falsifies
the record, lie to the patient, etc...?
At the very least, the very nervous student realizes that
whatever answer he/she gives will not be acceptable (even though
it may be) and this results in a feeling of defeat,
helplessness, and anger. The answer given will probably not be
given in a scholarly format because in the mind of the
candidate, he has already been defeated. You asked him a
question that really has no correct answer.
So, a long answer to your question is that from an educator's
point of view, this form of assessment is counter-productive to
evaluating a student. A question that fosters learned
helplessness is inappropriate.
A more appropriate format would be to review a malpractice case
and ask the candidate to act as an expert witness for either
side. This would show the ability to think "off the cuff" as
well as testing some academic content.
Dr. Joel Gluck
Professor of Human Anatomy
Warwick, Rhode Island
JGluc1@aol.com
______________
From: James Feltner, DPM
Subject: Residency interview question
I don't believe that the question has validity for judging
character. My reasons are:
1) the more savvy people will have 2-3 rehearsed approaches to
this type of question since they know it is likely to come up.
2) People will not always react the way they say they will or
even think they will when actually placed in the situation.
I hope I would always be honest and straightforward with my
patient while managing as much damage control as possible, but
at the same time, when people are placed under pressure,
perspectives change. Also when moral character of a residency
director or attending is corrupt, it makes for a difficult time
for the resident. Your best resident may seem wimpy and wishy
washy in the interview, but actually do the right thing by the
patient in the end, whereas the answer guy may just try to cover
himself.
One suggestion I have is for 1st year podiatry students to have
available a profile of useful and accurate information
(workload, duties, hours, important resident attributes, patient
population, etc.) from each program, so that they have an idea
of which programs their personality and interests are best
suited for. Sincerely,
James Feltner, DPM
jmfeltner@yahoo.com
___________________
From: Rich Cowin, DPM
Comment: Residency Interview Question
I understand your concern regarding the possibility of an
impressionable resident coming into contact with an attending
who displays immoral and unethical behavior. I agree
wholeheartedly that a physician like that should be chastised
through whatever means are available at the particular
institution and his/her contact with residents in the future
should be strictly limited or discontinued all together. The
question that I posed is designed to elicit a response from a
prospective resident that would give the interviewer some
insight into the ability of the individual to resolve a
conflict. Hopefully a resident at your institution will never
come into contact with a character like the one described in the
vignette, however, he/she is likely to be confronted with some
situation that poses an ethical dilemma of an or individual who
behaves in a less than exemplary manner. An open-ended question
that reveals how a candidate would resolve a problem or handle a
situation is a worthwhile question. Although, this was an
extreme example, some interview questions should be designed to
reveal a glimpse into the integrity, honesty, and interpersonal
problem solving skills that the candidate possesses.
Rich Cowin, DPM, MD
Past President, AAFAS
ADVFOOTSURGERY@aol.com
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