In my last blog post, we looked at some very engaging questions in teaching and research that you can and should ask the interviewer. Here's a continuation of that blog post. We will now focus on questions pertaining to clinical practice and training. Let's dive right in.
Clinical questions:
You will be spending an enormous time of your residency training at work. No wonder that your title is going to be a 'resident' who lives, breathes and works long hours in the hospital. You need to make sure the program can cater to your personal and professional needs.
A few years ago a common question was "does the hospital use paper or electronic medical records (EMR)?". But now as EMR is so prevalent in every hospital, more practical questions are "which EMR is used in the hospital?" "Is this the same EMR in the clinic (or at any other locations that you will need to rotate)?" "Do I have access to the EMR from home?" The VA hospital has its own EMR and so if you are in a residency program where you need to rotate in a VA hospital, it is very likely that you will need to learn a second EMR. While the learning curve to master a second EMR is going to be steep, some residents like the idea of exposure to a second EMR in case they have to eventually work at another hospital that has an affiliated VA hospital. Just make sure you understand what you are getting into. Every hospital provides orientation at the start of residency so it's not necessary to ask the interviewer how you would be trained to operate the EMR. I don't believe scribes are available to residents yet.
The cross coverage responsibilities are clearly addressed so that's not really an important question to ask. Also with ACGME duty hour regulations, the clinical responsibilities in every program are usually standardized.
For IMGs, you want to be sure that patients and hospital staff alike respect you, your hard work, your skills and experiences and willing to work with you despite your accent, personal preferences or skin color. I was once asked "What has been your experience about racism in this community?" I was taken a little aback by this question, probably because I never expected it. In the current times, I think this is a fair question to ask. You want to be in a program that embraces diversity and inclusion among your colleagues and everyone in the hospital. You want to make sure that you will have support if a colleague or patient makes racist comments against you. If you don't wish to be blunt by asking "Has the program witnessed events where racist comments were made to the resident? How was that handled?", you could rephrase to ask "How does the program support diversity and inclusion for residents who come from other countries?"
"Are there any characteristics about the patient population such as insurance coverage, special populations such as refugees or patients speaking a different language that I need to be aware of ?" Now this is not to be a factor in deciding whether to rank the program or not. But if you are interviewing at a program that has a large Spanish speaking population and if you do know Spanish, make sure your interviewer knows about it! Or, if you happen to find out that Dearborn MI, a suburb of Detroit, has a large middle Eastern population and if you have a middle eastern origin, letting your interviewer know this fact assures the interviewer that you will fit and settle down well in the community. When I interviewed at my current program, I was told about a large refugee population from Nepal and Bhutan in the community. So I asked the interviewer whether "interpreter services are readily available?" Thanks to this wonderful service available anywhere in the hospital through iPad, taking care of non-English-speaking patients is not an issue at all.
"I am very interested in developing point of care ultrasound (POCUS) skills as a resident. Could you let me know about the resources available for me to learn this skill? Are there dedicated faculty members to train me in POCUS? Is there a way for me to get certified in POCUS?" Point-of-care ultrasound training is being increasingly available to medical students and residents and is a fantastic skill to acquire. Some programs are just starting to incorporate POCUS in their curriculum. So make sure you will have some training in POCUS. "What procedures will I do as a resident? Are there a certain number of procedures that I need to do for graduation?" If you are in a procedure based specialty, make sure you know your responsibilities in doing procedures and the kind of interventional radiology or surgical support and backup available to you.
"Is there a simulation lab for me to learn codes or CPR training?" If they have already talked about the sim lab in the morning introduction, you may choose to ask more details such as "Which scenarios are simulated in the sim lab such as the ICU, cardiac arrest or line placement?" or "Who leads the sim lab for residency training?" or "How accessible is the sim lab at different times of the year?" Residents commonly have access to a simulation lab, especially if there's an adjoining medical school.
"Could you let me know how does the program provide balance between learning and clinical work?" "Are there any specialties that have a non-teaching service?" "Is there a non-teaching service?" While the goal of residency training is learning while working, sometimes it is debatable whether a resident would attain any educational value from taking care of a patient with chronic stable issues or who is waiting for placement into an outpatient nursing home. Some programs have hospitalists or nurse practitioners take over care of a patient as a non-teaching service. Do be careful when you ask this question as you don't want to sound to the interviewer that you are lazy.
"Is Uptodate easily available?" Uptodate is this wonderful resource available to physicians in the hospital commonly at every computer terminal (or even on phones and tablets nowadays) that serves to provide the latest evidence based information on any medical condition. It is also very helpful while you are preparing your case presentations for morning report and need help with a comprehensive summary of the research literature. You can also look up drug doses. In the current times, I can even say that any hospital that does not provide access to uptodate is doing disservice to its physicians and residents.
A question that can lead to more questions:
"Is there anything you feel I need to do so that I can best prepare myself if I were a resident at your program?" Now this is a tricky question. You are subconsciously putting in your interviewer's mind that he or she should accept you into their program. Some interviewers may fumble as this would mean a critical review of your application to identify deficiencies or areas for improvement. But some may counter your question with "Nothing that sticks out right now. What exactly do you have in mind?" Caught in your own trap? How do you answer this? "I was wondering if I may need an accent reduction program?" or "I was wondering if being able to observe the residents a few weeks before the start of residency can help me get off the ground quickly especially with learning the EMR?" Don't over do this. I would suggest asking this to just one interviewer (probably the program director).
That's all for now! The next blog post will have questions on resident evaluation, the back well-being and other questions that you can ask the interviewer at the residency program. All the best! Do join the mailing list to get the latest blog posts delivered right to your mailbox and leave any comments below.
Before you go: Here's your golden opportunity to have your voice heard! Write down your ONE question regarding your US residency program application, personal statement, interviews or anything that has been bothering you and keeping you up at night. You can reply at the end of this blog or post a message at my Facebook page or email me at varun@ed4medus.com
The top 10 popular questions will be featured on my next blog posts at https://ed4medllc.blogspot.com/ and the winners will receive a coupon each for a FREE practice interview at Ed4medus.com ! Put those thinking caps on and hurry up!
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