"Tell me about an event where you did not agree with your senior or attending. How did you handle it?"

 

You may wonder why there would be disagreement between a medical student and the attending? This is commonly because an important piece of detail often gets overlooked or missed because of error or preoccupation with another event.
Just like the movie ‘Batman Begins’ where Bruce Wayne is asked to hurt a civilian for some wrongdoing, instead of hurting the man, he lights a fire in the league of the shadows and escapes to Gotham City. This is an example where he disagreed with this superiors. What are possible scenarios appropriate for the residency interview?

Here are two examples where the applicant was in disagreement with his or her superior.

 

Example #1 

This is taken from an online practice interview that I performed at ed4medus.com. Click on the link below to listen to the audio clip. You can read below the transcript of this clip from the interview. (Identity of the applicant has been withheld to ensure confidentiality).

"Tell me about an event when you did not agree with your senior or attending. How did you handle it?"

Dr Ed: ...and so certainly you were working as part of a team like you mentioned with the senior resident and attending. Was there any time you came across a situation where what the attending or what the senior resident was telling you was something that you felt was not the right thing to do. Something that was wrong and so what did you do in that situation? GM: Well, there was one case. It was a surgical case. We were at the OT (operation theater) and my attending was performing an operation. I was the one who was assisting him. It was a neck node dissection (radical neck node dissection) and while he was operating, I could see the pleura, the pleural lining of the lung coming out of the surgical field. But he missed it. And he was about to reach it. So, I immediately pulled his attention towards it and made him stop. At first, he didn't believe me. He never thought the pleura was a bit higher than the usual level because the patient already had fibrosis due to the previous surgery due to scars and all. And the pleura was much elevated than the usual site. But I could see it blow in and out because from the position that I was standing I could see it clearly. But he missed it because he was standing in a sideways position. So, I made him see it through my position. I cleaned the whole surgical field and made him see it clearly and he understood his mistake and apologized and he really thanked me that day for not letting him do such a mistake. Dr Ed: Fantastic!

Example #2

(Source: facebook.com/groups/ed4medus/) There was this time when I just finished writing my research paper and I had a disagreement with my mentor about which Journal we should be submitting that paper to. I wanted to submit my manuscript to Circulation, a high impact journal, as I felt that would be great for my research career and it could reach a much larger audience though I did realize that Circulation is a very competitive journal and it is difficult to get a paper published in it. My mentor felt that we should submit it to American Heart Journal, a respected cardiology journal but with a lower impact factor.  I looked at the papers published in Circulation and found a paper published just under a year ago that was very similar to my study design and the question that it was trying to address. This gave me confidence and I approached my mentor with this information. I asked him for his thoughts about trying our hand in Circulation and that the worst that would happen is they would decline my manuscript and we could then submit next to American Heart Journal. He reluctantly agreed and I submitted my paper to Circulation. After a few weeks, we heard back from Circulation and the editor and 3 reviewers were willing to reconsider our paper after a major revision. Both I and my mentor were very happy about this response and very glad that we chose to submit to Circulation.

When answering this question, make sure you are not suggesting that your senior resident or attending has a poor character or incompetent or lacks sound judgment (this maybe true but the residency interview is not the place to belittle those who contributed in whatever minute way to your medical education).  

How should you not answer this question? When recounting the event, NEVER show that (1) you know more than your attending or (2) you can get away with doing things behind their backs especially ordering medications or tests (requesting additional medical or surgical input is not too terrible, though as basic courtesy, do let your attending know what you are doing). 

Do share your thoughts in my facebook group and I can comment on your response. Plus, you can see other's responses too. 

That’s all for now. Hope you like this post. I would love to hear your thoughts and comments. Join the mailing list or my facebook group and check out Ed4medus.com to learn more about personalized services to help you get into a US medical residency program.

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"What are the problems in the US health care system that you have come across and its solutions?"

I will start off by saying that no healthcare system is perfect.  When you think about healthcare being free and completely covered by the government [such as the National health services in UK or Canada], you hear about the long waiting times, difficulty being able to see a specialist and so forth.  Then when you consider a healthcare system like in US where you wish to do your residency training, you hear a lot about costs of healthcare and that the rising costs are not sustainable.

While this can be a very long drawn political discussion, let us focus on this question that may be asked at your interview on US healthcare.

"What are the problems in the US health care system that you have come across and its solutions?"

Now the list of TEN problems in the US healthcare can be long and daunting, but remember we need to answer from the point of the applicant who is getting ready to train for independent practice. Here are the problems that one may face practicing in the US healthcare system and FOUR solutions for the problems that I feel are practical and feasible:

1.  High drug costs:  There is a lot of debate as to how to control the drug prices in this free market.  Sadly, it is the patient who suffers the most. I really do not know how to address this by myself.

2.  Costs of care.  Again the reasons are numerous and no one knows whether the drug prices by the pharmaceutical companies, rising number of administrators who are turning healthcare into a business or growing complexity of medical care are the reasons behind this.  Again this is something that I myself would not be able to resolve.

3.  Access to care.  This is with regards to the long waiting times that some communities may face in trying to get to see a physician or healthcare provider [physician assistant/nurse practitioners].

How can I help improve access to care? Without going into the details of which insurances my practice would accept, the way I try to improve access to care is that when a primary care physician or the patient themselves call and request to be seen urgently, I always make room in my clinic and accommodate them as best as I can. This is especially important in a place of practice that has limited physicians.  Being available to meet with the patient's and/or their families in my opinion resolves prevents any conflicts and at the very least shows that you are putting an effort to listening to the patient and addressing their concerns. I agree this is not a sustainable option, but at the very least you are trying. 

Another method that I believe can help access to care is telemedicine.  I really think there is a lot of potential and telemedicine can reach out to patient's quickly and efficiently and also interact with other physicians especially in rural hospitals.  A lot of work still needs to be done with regards to regulation, reimbursement and malpractice coverage but imagine how great it would be if a Dr. can check you out with available technology at the comfort of your own home.  This is one area that if you read up a little bit more about you can actually identify specific strategies to help the healthcare system.  In this day and age, I would also encourage young physicians like you to take up creative projects and embrace the use of telemedicine to improve access to medicine.

Having more physicians is going to be tough especially with the high tuition cost of medical school and salary to pay the attending physician. More PA/NP is another attractive option, but I don't like the fact that hospitals are 'replacing' physicians and the administrators are loving this idea. I still think there needs to be regulation/supervision of PA/NP providers, so instead of improving access by just hiring more PA/NP, you could say that you would like to be in a setup where you can supervise them and see more patients in a day. I think that would be a great idea.  

4.  Fear of being sued.  The fear of being sued dictates some of the decisions that we physicians make while providing medical care.  Some have an approach of CYA [cover your bottom] that can sometimes lead to superfluous and extraneous care.  Where to draw the line on medical care is difficult to know though some states have a limit as to how much the physician can be sued for.  Again this is not something that I can fix by myself.

5.  Abuse of the healthcare system.  There are situations where a person may ask to be in the rehab center if they have minimal support at home.  This is a rare occurrence though.  Things like opioid abuse really strain the healthcare system.

6. Lower focus on preventive (and patient education) rather than curative care.  It certainly makes a lot of sense that focusing our efforts on prevention such as with vaccination, cancer screening, screening for cardiovascular disease, healthy lifestyle choices to prevent obesity will yield much higher returns in population health than curative care.  This is something that a physician can strive to implement in his or her clinical practice.  For example, in the field of nephrology, a lot of important work has been done with regards to patient education before dialysis and her chances of getting a kidney transplantation, vascular access and some studies have even shown an improved survival with patient education after that patient starts dialysis.  I think this is a growing field and the hospitals are really starting to use social media to improve patient awareness of health conditions. Diabetes care diabetes care is improved a lot after having diabetes educators and other chronic health conditions should also follow this trend.

7.  Healthcare wastage.  Every physician witnesses provision of care that is futile such as an elderly patient with terminal cancer getting a tracheostomy, tube feeds and being on dialysis.  Again, better patient communication, research in these complex areas of medical care can help address this problem.

8.  Patient safety.  Because of the growing number of teams taking care of different parts of the patient's medical care, patient safety has become an important concern especially when there is breakdown of communication.  This is something that you as a physician can fix by being a better communicator, talking with patients, families, other physicians and being more collegial and collaborative with other providers of the care that can help improve patient safety along with better documentation. Having safety systems in the hospital, AI will be employed in the near future to catch the near-misses. You can also participate in the hospital safety committees and strive to improve overall patient safety. 

9. Reimbursement of care.  Physician practices suffer a lot financially because of inconsistencies in how practices are reimbursed for care.  There is a lot of unhappiness about this and some practices even tried to game the system to increase reimbursement.  Sometimes these practices can be unethical.  Again this is something that I do not know how to fix by myself.  Some physicians are looking to practice " concierge medicine" that might avoid these problems but it is not perfect and is still evolving.

10. Last and my favorite is physician burnout.  Yes you heard me right 'physician burnout'.  About half of the medical doctors across-the-board [residents, attending physicians] in US report symptoms of burnout.  These physicians feel exhausted emotionally in their ability to take care of the patient and sometimes have reported feeling callous about the patient's concerns.  A lot of research is actively being done to study causes and Rx of physician burnout.  There are a host of personal (compulsive behavior, striving for perfection, lack of social support) and workplace related factors (workload, lack of control over schedule, non-clinical work) that lead to burnout.  You may have also read in the news about physician self-harm and suicide.  It is felt that the rising nonclinical workload such as documentation in the electronic medical records have added and contribute to the menace of burnout.

This is an area that you can actively intervene upon and make changes.  It is no surprise that if you are in the best mental and emotional state, you will do a better job taking care of your patients.  The solutions can range from personal [better lifestyle choices, exercise, yoga, meditation, mindfulness], trying to achieve better work life balance [this often means refusing to take on additional responsibilities when your plate is already full], better electronic medical records training, use of scribes [if possible], extracurricular activities such as music, art or community service, or cutting down on part of the work that makes you unhappy such as night calls/weekend calls especially when financially independent, improving collegiality with your other team members at work are very possible strategies to improve the joy of clinical practice.

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"Tell me the time when things did not go the way you wanted. What did you do in that situation?"

Life is very complex. Let's all agree that things happen and don't always go our way. But what does that have to do with a residency interview? Behavioral questions are popping up in residency interviews. "Tell me the time when things did not go the way you wanted. What did you do in that situation?" is fair game. I even created a facebook announcement for people to share their responses to this behavioral question.

While a lot of you have great experiences in life, this is a great response from an online practice interview that I conducted a little while ago.

Q. Tell me the time when things did not go the way you wanted. What did you do in that situation?.

A. "Yes, I can tell you a certain thing that did not go my way and this has to do with the time that my visa application to come to the US and take the Step2 CS exam was declined. This happened after I took my Step1 and scored very well at 252. Soon after I got my score, I then applied for visitor visa in February of last year to come to Philadelphia and take Step2 CS. A month before the CS, I went to the US consulate for the visa interview and for some reason that I still don't know today, my visa application was declined. The officer would not give me an explanation. This was very disappointing and distressing to me as I planned very meticulously for the Step2 CS, then Step2 CK, observership and applying for residency. I remember that my mother was also very concerned for me.

However, I took it as a challenge to make a stronger CV the next time I would apply for the visa as the more rejections you have, your future chances of getting a visa become lower. I reached out to seniors from my med school who are doing residency in the US and asked for their opinion. We found out that my applying for Step2 CS after Step1 was not the right thing to do. I thought about it and realized that I applied for Step2 CS sooner rather than later because I was very fresh from my internship year and had very good clinical skills. My seniors advised that I take my Step2 CK first and then apply for the visa to take Step 2 CS as I could then show the visa officer that I am serious about getting into a residency.

I was unable to apply for residency last year, but I made up my mind that I would not let my high Step1 score go waste. I studied hard for my Step2 CK and scored 249. After that, I applied for the visa to take my Step2 CS and this time I showed the visa officer that I had completed the Step1 and Step2CK and that I needed the CS to get ECFMG certified and then get into a residency program. The visa officer looked at my scores and I think she took my case more positively than the last interview and granted me the visa to travel.

So this is where things did not go my way but just by taking a step back, reaching out to others for help and information and then working towards making the necessary changes rather than being bogged down and disappointed helped me be successful in getting the visitor visa and making it to today's interview.  In retrospect, I think the first time I applied for the visa, I was a bit oveconfident after I got my Step1 score. The visa denial challenged me to do even better and have even a stronger application and so I take this experience positively."

You can see that this response described the events and how the young doc made the best of this situation to achieve great success. What is your story? Do share at facebook.com/group/ed4medus/ and I can comment on your response. Plus, you can see other's responses too.

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"If you had unlimited research funds, what would you study and why?"

The facebook.com/groups/ed4medus/ is starting to generate a lot of great interaction between the group members. Thank you for your contributions. Here is the first question:

So the question is what research do you want to do and why.  Let's first understand the rationale behind this question and what exactly is the interviewer looking for. I briefly discussed it in my practice interview with SS in a prior post, but lets look at it in more detail. 

Why is the interviewer asking you this question?

Overall this is a test of your critical thinking skills.

I believe the interviewer is asking this question to get a sense of which medical condition or problem hits you most at the heart i.e. which medical condition (acute or chronic) are you passionate about the most. Is it something that you feel you can do better than others? Is this something that you cannot withstand anyone else doing a sloppy job? Is it something that wakes you up in the middle of the night in a cold sweat and you are absolutely not willing to cut corners when trying to do your very best for the patient with this medical condition.

The interviewer could also be evaluating if you have the right research outlook i.e. the ability to identify that there is a real need to solve a medical problem in the community and that possibly you have the fire to take the lead in making a difference to patient outcomes. 

The interviewer may also be testing your medical knowledge in this way and wishes to know if you are following the research literature about latest developments in your disease of interest.

This may also be caught as a way of trying to really gauge your interest in that specialty.  For example, some internal medicine applicants do apply to a second specialty such as pediatrics or psychiatry. When you are at an internal medicine interview, it is going to look very awkward if you would like to find safer alternatives to electroconvulsive therapy for major depression or develop newer therapies for ADHD. So think about it and make sure you are well prepared. This is a bit similar to 'Tell me an interesting clinical case'.

The interviewer is also getting to know you better as a person through this question and is trying to understand why you feel that medical problem is important to you. Was there a family member afflicted with that disorder? Did you personally get affected by that problem. Now is the time to tell so.

What is the interviewer expecting you to answer?

I believe the interviewer wants you to self-reflect and ask yourself what medical condition would you be most interested in. There is a common saying in internal medicine residency that when are choose a subspecialty fellowship, think of the ONE chronic medical condition that you are very keen in resolving. It could be atrial fibrillation or stroke or MI or GI bleed or prostate cancer or COPD or asthma or rheumatoid arthritis but there has to be JUST ONE chronic condition.

Can you give an example?

Your answers could range from anything like diabetes or hypertension or more specific conditions like pulmonary hypertension or MI or esophageal cancer or even society's ills such as tobacco cessation or reducing salt intake.

This would be my response: 

"I would be very interested in studying obesity.  Obesity is a major medical problem affecting one third of the US population. I myself have seen my mother as a victim of obesity and its complications, that is, diabetes, hypertension, sleep apnea, osteoarthritis. We have absolutely no approved medical therapy to address obesity.  The endemic of obesity in my opinion is because of increased insulin from high carbohydrate intake.  If I had all the research funding, I would really like to study how a diet that is high in fat and protein, but low in carbohydrate such as the keto diet could help with weight loss and also improve outcomes of cardiovascular events and even survival. This is because I truly believe that 'you are what you eat'. My research would also serve to update national guidelines such as the American Diabetes Association guidelines that currently has recommendations on a low-fat diet but discourages a high fat diet that I intend to study. This research would help millions with obesity and diabetes in the US and the world."

What's my reference for this example. The Ted talk below:

Reversing Type 2 diabetes starts with ignoring the guidelines | Sarah Hallberg | TEDxPurdueU

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"Do you plan to return to your home country after residency?"

Listen to this audio clip of an online practice interview that I recently conducted. My question to the applicant was whether she had any intention to return back to her home country after residency training. You can read below the transcript of this clip from the interview.

Interview: "Do you plan to return to your home country after residency?"

***

Dr Ed (me): And I also saw that in your personal statement you talked about a shortage of qualified primary medical physicians in India and you also talk about how you want to probably make some changes in policies or try to improve upon that so that it is not going to be a financial burden.  Does that mean that after residency you plan to go back to India?

SS: Okay, so Dr. Ed, my most important thing that I feel as a doctor is reaching out to people who really need your help.  If I have the knowledge and skill, and I am not able to provide it to the people who need it the most, I will not be able to justify my knowledge. And I have this feeling that we have a certain section of underprivileged population not only in India, but across the world. And it was my experience in India that I had witnessed this kind of disparity in healthcare provisions.  But my work tomorrow after residency or fellowship is going to address the needs of the people not only in India but across the world.

***

Okay, so what just happened here in this interview exchange? Did the applicant answer the question that was asked?  Are you satisfied with this answer from the applicant?

The question was structured to have a 'yes' or 'no' answer. IMHO, my question was not answered directly or may be even indirectly.

I do realize that when an applicant who is an international medical graduate is asked this question there are certain aspects that make it confusing to frame an answer. If you say that you plan to return to your home country right after residency, then the interviewing faculty member is quite likely to think that "you are not serious about residency training" or" that is a crazy thing to do" or" why should we train you and spend all the time and effort for you just to go back to your home country".  Yes, many of us do have a sense of patriotism towards our home country. In reality though, US residency programs train you to practice only in the US (OK, some may argue that some procedural skills can be applied in any country).

On the other hand, if you say that you plan to stay in the US after residency, that is a fine answer if you are serious about it. This response is not considered negatively in the mind of the interviewer, though it may lead to more questions such as your plans after residency training on a J1 visa [that requires you to return to her home country for 2 years]. And for some, it is very difficult to say it straight to the interviewer and commit to staying in the US permanently after residency training for a variety of personal reasons and family reasons.  I get that.

My answer to this question would be as follows: "Dr. Ed, I gave a lot of thought to that question.  Because my parents and all my family members are based in India, it is difficult for me to say most certainly that I will be settling in the US after residency training.  At this time, I am very much focused on working hard in residency to become an excellent physician at the end of my training. I do plan to work a number of years after residency so that I can apply all the skills that I learned during residency to practice medicine comfortably and independently. At that time, I will be in a better position to decide whether to settle in the US or return back to my home country."

I feel that the above response shows that you have given serious thought to plans of settling in the US after residency and at least for now have a plan in mind as best as you can. It also provides a clear answer to the interviewer.  No one can predict the future and what that may bring but sharing your thoughts with the interviewer freely and confidently will satisfy the interviewer.

What you think about the above response?  Do think it is balanced or still ambiguous?  Writing your comments and do share with your friends.

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"Tell me about your strengths and weaknesses." Weaknesses. What you should NOT say.

In the last post, we looked at 'weaknesses' that you can and should safely disclose when asked at the interview. But how far can you push this? At what time, does a weakness become a reason to turn off the interviewer so that you lose your chances of making it into the coveted rank order list. Here are some 'weaknesses' that in my opinion should NOT be said (at the least in the words below):

1. "At times, I feel I am not confident of my English language."
Now that's just not true. You may feel that English is your second language esp if you are an IMG. If you have mastered the USMLE Steps including the CS, wrote your personal statement and are invited for an interview, English IS your first language and you have an EXCELLENT command of the English language. There is no room for modesty here. You may talk about your accent and that an accent reduction program would be helpful, but again there should be absolutely no questions in your mind about your knowledge of the English language.

2. "I don't sleep at night because I keep thinking about patients."
The first response in the mind of the interviewer is 'this person needs help'. No one wants an insomniac in their hospital as this leads only to burnout. You need to demonstrate that you have some degree of work life balance and the above stated 'weakness' shows that you have none.

3. "I am very anxious."
Again, no one likes to be around a nervous Nellie (a timid person who is easily upset and is hesitant to act). Even though you may add as to how you have overcome your anxiety, claiming that you are anxious borders on having a personal diagnosis of 'generalized anxiety disorder'. Medicine has many stressful moments and the last thing an interviewer wants to deal with is someone paralysed with anxiety.

4. "I am a procrastinator."
Oh boy! You do like to get yourself in hot water. It does not matter whatever changes you have made in life, but procrastinating in training and clinical practice is just bound to cause failure and trouble for yourself and your team members. Don’t say this.

5. "I feel that I am weak in my writing skills."
Well, then how did you write your personal statement? You can't say this as a weakness. Writing (and documentation) is a very essential communication skill of a resident. You may temper this statement by saying 'I feel that I need to make my writing more impactful when I am writing a research paper. I have improved by reading more research papers in NEJM. I hope I can work with you in residency to get 1-on-1 guidance to write concisely and accurately.'

6. "Lack of confidence is a weakness of mine"
OK, how did you make it so far into the residency interview if you have no confidence? Lack of confidence or experience is just not a weakness. You may say 'I am shy' or 'introvert' (see my earlier post), but still in those situations you are very confident about your medical knowledge and clinical skills. So pls pls, never say that you lack confidence.

7.  "I have trouble working with others in the team", "People take advantage of me", "I cant get things done" or "I can't stand another person's incompetence" are simply NOT to be said.
Medical practice is a team effort. You absolutely need to be a team player. You can't boss around or be arrogant. This sort of behavior is just not tolerated in the current times and certainly your interviewer will not tolerate it.

8. "I have trouble asking for help."
Again, not asking for help either in your personal or professional lives is going to just leave you more frustrated, upset and burned out than ever. Now, 'trouble asking for help' is just a tad different from 'difficulty delegating work' (see my last post). I feel that in 'difficulty delegating work' that was discussed in my earlier post, you have decided to ask for help, but just don't know how to request for help. Saying "I have trouble asking for help" means that you are just going to stand there paralyzed in misery.

Always remember: Unlike some cultures, asking for help is NEVER to be considered a sign of weakness in an US residency program. Better safe than sorry. 

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"Tell me about your strengths and weaknesses." Weaknesses: What you CAN say.

"Just like losing a game does not make you a 'loser' in life, having a 'weakness' does not make you a 'weakling'." - Ed4Med LLC

Honestly, I do not like the word "weakness" or "failure", even though I deal with kidney failure on a daily basis at work.  "Weakness" has such a negative connotation that it implies loss of any hope.  But, that is just not true when it comes to performing in a residency interview.

'Tell me about your weakness' is a common question in a residency interview and I feel that interviewers spin this question in a myriad number of ways by asking for your 'areas of improvement' or 'How do you think you can improve your self' or 'how have you changed yourself' or 'what are the areas of improvement that you foresee for (or identified) in yourself' and so forth.

The intent of this question is for the interviewer to evaluate whether you possess the skills to self-reflect, identify shortcomings or errors or areas of improvement, make necessary changes, intervene and develop yourself professionally or personally so that it is no longer a 'weakness'. Or rather, you can think of this as an opportunity for you to do a "confession" and "repair and recovery".

But what 'weaknesses' are acceptable or even tolerable in a residency interview? There needs to be a balance between being upfront and truthful to the interviewer but at the same time not to blow your chances of being ranked high by the residency program. Here are 9 examples that I feel are applicable in the medical residency interview and some may also be applicable to life. Note how you first stage your weakness, then provide additional context or an example and finally state how you fixed this" weakness".

These 'weaknesses' were shared with me during the online practice interviews. I usually push the applicant to state their 3 weaknesses. The initials of the applicants who described the 'weaknesses' are provided (you know who you are). There are also some 'weaknesses' in the bottom of the post that are non-traditional, though in my view, seem fair in the current times.

1. Feeling of 'not enough time' or 'trying to be perfect'

RH: I feel that I was spending too much time learning every little fact of medicine. This was leaving me frustrated when I failed to recall certain details that, in hindsight, probably would not have affected the clinical course of the patient. For example, I now realize that I don't really need to know the mutations for polycystic kidney disease but I do need to know the importance of taking a family history and looking for kidney and liver cysts in polycystic kidney disease. I changed my approach when I started preparing for USMLE and also because the finer details are now  easily available on the computer and the phone. I now focus more on clinically relevant information. When I did an observership in University of __, I really liked how residents used uptodate to answer a focused question. I feel less overwhelmed this way and feel I can enjoy practicing medicine.

PP: There was one weakness that became apparent to me when I started to write a review paper with my mentor.  This was a paper on the impact of bariatric surgery in patients with diabetes. There are many research studies, editorials and perspective papers out there. When I started to write the manuscript, I wanted to download and print all the 60 or 70 citations and read them all. I wanted to feel perfectly confident that I could write only after mastering the literature. This was my weakness as it just caused me to be more stressed and frustrated and I didn't make any progress in the manuscript for about a month.  My mentor then suggested that I read no more than 5 original papers published in the last 5 years as a starting point. She also encouraged me to start writing after I finished reading these 5 papers and then to make additions or subtractions in the manuscript based on further reading.  I really loved this idea and implemented it right away and noted a lot of progress in my manuscript.  I believe this strategy will be useful when I do my case presentations as I know that I can read up to 5 selected papers and start working on the PowerPoint slides in my limited time. I realize that it is not possible to know it all.

2. Conflict between introvert and extrovert

MR: My parents tell me that I am an introvert. During my time doing elective rotations in the US, I felt that I was not good at maintaining conversations outside medicine. I don't feel I avoid social interaction, I think its a cultural difference. So, I took two passions of mine -sports and Indian cooking and I explored how I could have an engaging conversation in US. Growing up in India, the only sport I knew of was cricket. After coming to US, I learned about baseball. I now know the famous teams, players, rules, Babe Ruth, though I haven't bought baseball cards yet. Similarly, with cooking, I only knew about Indian cooking. The one favorite Indian item I make is called 'Biryani'  because you can just give it so many different flavors. I have found that Mexican cuisine is quite similar to my style of eating rice and vegetables.  I am trying to mix Indian and Mexican items and trying out different rice based foods and would love my colleagues in US to try.

MC: Growing up, I was told that being an introvert is a kind of weakness. Going through medical school and working in teams, big and small, in sometimes stressful conditions, I realized that my preference is that of a small group of people whom I can develop relation and trust. I have read about the MBTI types and believe that being an introvert has some clear advantages. I work best by carefully processing the information available to me and make decisions by thinking through the problem, rather than making quick decisions by emotion. This is another reason why I chose to specialize in internal medicine as I really feel that I am a 'thinker' and then act by reasoning. I will find myself more at home in this smaller class in a community hospital where I can develop close relations with my co-residents and attendings.

3. Difficulty in delegation of work

JB: One thing that I feel I could work on some more is my skill of delegating work to another person.  Being that I like things to be done in a certain way perfectly and on time, I usually just give up asking another person for help and do it myself. I find that at times, this leaves me tired and I wonder if my extra effort was worth it. And I have improved by ability to delegate some of the work by clearly explaining to the other person why a certain work needs to be done and I provide very clear instructions. For example, when I was rotating in medicine at the __ Medical Center, and if I wanted to get records from an outside clinic, I would previously tell the unit secretary to get all the notes and lab work from the primary care office faxed to me. I later realized that because of unclear instructions, this almost never got done and because of the delay, I would end up having to call the office myself. Instead, what I have been lately doing is I would first check with the patient when was the last blood work done and I would specifically tell the unit secretary that I need her help to obtain the basic metabolic panel reports done in the last 6 months from the primary care office of Dr. such and such, so that we can plan the biopsy procedure tomorrow. This way, the work is more likely to be done and I don't feel remorse if things don't get done to my satisfaction. And yes I do thank the unit secretary for her help.

4. Difficulty in saying 'no'

TL: I sometimes find trouble in saying 'no' to requests from my colleagues at work.  In the past, this has often caused me to feel stressed because I would end up taking more work than I could handle. Also, I sometimes felt that people would took advantage of me as I would easily give in. My family is very supportive and I noted that my difficulty in saying 'no' took away precious time from my family.  After I realized this weakness, I am now able to do a better job organizing my time and balancing my work and family time. I am still happy to jump in and help my colleagues in times of emergencies or family illness, but I don't feel bad about politely refusing if someone asked me to, for example, write an abstract for someone especially if my contribution is not going to be mentioned. I do make it a point to explain why I am declining the request so that I can still maintain a healthy relation with the other person as I may need their help at a later time.

5. Weakness outside medicine.

RF: I have a difficult time understanding financial planning. This is because of different view points of my father and brother.  My father believes in saving for retirement, while my brother who lives in Los Angeles, a high cost of living area lives paycheck to paycheck. I do worry a lot about how I am going to pay my student loan and make sure that I and my family will be financially in the good situation at retirement. What I have done so for is that I started reading financial planning books by physician authors. In fact, my favorite podcast is called White Coat Investors. This is run by Jim Dahle, an ER doctor. He gives very practical advice and my favorites so far are not to buy a house in residency, buy a used car, and to live like a resident for a few years after becoming an attending. I now have better knowledge of saving for retirement like the 401(k) plans and believe that I am going to be okay if I am careful with my spending and do not take unnecessary debts.

AA: Belonging to the LGBTQ community, I used to get very angry and upset when someone used to treat me differently or say not shake hands with me.  While I have got used to how people react to my gender preferences, I have learned to be more forgiving and make an effort to educate the other person that I am no different than him or her.  Fortunately, in the current times, people have become more tolerant and that is one of the reasons why I am applying to your program as I feel I will be readily accepted by the patient and physician community here.

MP: One of my weaknesses is that I have not invested enough time in staying fit. In the first two

years of medical school, almost every waking moment was spent in reading and learning about medicine.  As I moved to the third and fourth years of medical school, I realized that I need to be in top shape to do my best taking care of the patients on the floor. I now start my day with a brisk run on my elliptical and I have also enrolled in yoga classes.  In fact, I find that something is missing if I do not get any physical activity in the morning. Because of my morning routine, I feel physically and mentally more alert to work in the hospital now.  I have also now started more outdoor activities in a way to get me away from my iPhone.  I would be interested in trying skiing though I have heard a lot about experts falling and suffering an injury.  May be I will try beginner slopes.

It can certainly be hard to answer the question "what are your weaknesses?" But framing your weaknesses as a strength with careful practice can help you sail through this unpleasant question and still stand out from other applicants. Learn how Ed4MedUS.com helps applicants do their best on interview day and sign up for an online practice interview now (Low introductory rates $29 for this year). 

Hope you liked this post! What's your greatest weakness? Share in the comment box below and I can then reply with my comments. 

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"Tell me about your research" Example 2 of 2 - research survey

In the last post, I shared with you the interview exchange between an applicant and the interviewer about her public health research project. In this post, let us look at another applicant [AK] who very enthusiastically shares with me [Dr Ed], in an online practice interview, his research survey that he completed before applying for residency.

Pay careful attention to how he describes the research methods, findings and how he did not settle for just data collection, but moved the project forward to the point of abstract submission in an attempt to present at the largest diabetes conference. Also, have a look at the time-frame when he was able to accomplish all this as it gives you valuable practical information.  Let us start... (Note: Personal information has been withheld to protect the identity of the applicant).

***

Dr. Ed: You indicated in your research experience that you were at __ University doing research in diabetes. Can you describe the research study to me?

AK: Certainly. When I was in (city) staying with my family preparing for Step 2 CS and Step 3, I worked as a research assistant in the Endocrinology division at __ University. The diabetes clinic was situated in downtown __.  I started the research work in May of this year. Dr.__, with whom I worked the most, had created a survey on patient knowledge of diabetes. My role was to survey the patients in the waiting area of the diabetes clinic.

It was a busy place and I was able to survey 106 patients for the study. The questions focused on patient's understanding of what a hemoglobin A1c is, what is the target A1c and what was their recent A1c as far as the patient could tell. After I completed the data collection by the end of August, Dr.__ showed me how to do a basic SPSS analysis. We found that half of the diabetic patients had no clue to what an A1c was, a quarter of the patients heard of the A1c but did not know the target A1c and another quarter knew what an A1c was and their A1c target. We took this one step further, pulled every patient's A1c from the medical records and worked with the biostatistician to look for a relation between knowledge of the target A1c and their actual A1c value. The most interesting finding was a statistically significant trend between a greater knowledge of A1c and a lower patient A1c, that is, a higher patient awareness of the target A1c was associated with better glycemic control in diabetes. I wrote the abstract for this study as the first author and we plan to submit the abstract for oral presentation at the American Diabetes Association conference.[AK then shows me a printout of these findings with a pie chart and bar graph]

Dr. Ed: Very interesting. How do you explain that better awareness of the target A1c led to improved diabetes control?

AK: Our study was not really designed to answer that question and so we could only report the association.

Dr. Ed: Right, right. You used the word 'associated' and not 'caused'.

AK: Yes, we discussed a few possible explanations. Patient knowledge of target A1c, to me, could mean that the person is educated and motivated to take better care of himself or herself and thus may make healthy lifestyle changes such as healthy food choices, close monitoring of the blood sugars, following up with the physicians or working with the diabetes educator.  These are some of the possible reasons for our findings.

Dr. Ed: Right, that's possible. What was the demographics of the patients you surveyed?

AK: The average age was 64 years. Most of the patients were of African - American ethnicity with low socioeconomic status and low educational status.

Dr. Ed: What do you plan to do next with this data?

AK: I wrote the abstract as the first author and I am waiting to hear back from the co-authors. Dr.__ encouraged me to submit it to ADA for oral presentation and I will be very curious to see the response. If it does get accepted at ADA, I will then work on the powerpoint slides or poster. I am interested to learn how to write the manuscript and do realize that its a steep learning curve. With the help and support of the research team, I believe I will be able to complete a first draft by the time I start residency.

Dr. Ed: Did you also look at blood pressure in this study? That is, if knowledge of their blood pressure target led to improved blood pressure control?

AK: In our study, we did not find that knowledge of blood pressure target was associated with better blood pressure control. Dr.__ was very keen on studying this. I saw patients with her in the diabetes clinic as part of my observership and she would ask the patients about their goal blood pressure. It was fascinating to watch some patients who knew their blood pressure target were not happy if their blood pressure was 150/90. She has written about 'physician inertia' and that if patients know enough about their medical condition, they may question the doctor on how they could do better and thus overcome the 'physician inertia'.

Dr. Ed: This certainly sounds like a very talented team of researchers.

AK: Yes, I feel very fortunate to be a research assistant in this endocrinology division. I gained very valuable first hand experience in survey design, conducting the patient interviews, learning analysis on SPSS and presenting the data to the division.

Dr. Ed: Great! Let's move on and see if you have any questions for me?

***

Again, you will see that the applicant did an excellent job describing his research study concisely, had a deliverable (printout of the important data with pie chart and bar graph), and fielded followup questions thus demonstrating his ability to critically think and know the ins and outs of his project.

Preparing yourself for the interview by a careful reflection of your learning experiences, as in this interview exchange, can certainly improve your performance on the interview day and increase your chances of being ranked high by the residency program.

Check out ed4medus.com and learn how personalized services such as online practice interviews can help you in your goal to a US residency program. 

Before you go: Here's your golden opportunity to have your voice heard! I am working on some of the questions that you asked (including this topic). But I need more questions!

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 post or 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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