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By DAVID LEVIEN, MD, MBA, FACS
After having interviewed hundreds of medical students who were candidates for our surgical residency, several important questions come to mind. These issues are important to the doctor in practice because the product of said training will be future partners and colleagues and the cost and hassle of said training will affect the debt these new colleagues must sustain, the quality of their training, and, perhaps, their attitude toward authority. This author has not been a Chairman or Program Director for over 5 years, and many Orlando Medical News readers may have more information.
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Firstly, why do we make medical students jump through hoops by writing a personal statement. We are forcing them to write what they think we want to hear. I have read every single one of them for those that were invited to visit, out of respect for the student. We made them write it. We should read it. They are mostly all the same. They almost all cite an older role model, someone influential in their life, as the impetus to pursue our specialty. This motivation is admirable, but it doesn't necessarily mean they will enjoy spending the bulk of their days in the operating room or that they have the aptitude for it. They invariably cite an affinity for building things, working with their hands. I knew a respected Chairman who gave applicants an intricate model of a sailboat to assemble and I have heard that dentistry programs asked candidates to carve something from a bar of soap. Perhaps such practices still exist but I am unaware of evidence that they predict job performance. The modern-day equivalent might be performance on a simulator. The personal statements routinely cite the desire for efficacy, seeing the fruits of one's labor. Occasionally a personal statement comes across as really clever which makes us suspicious that there's something a little off about the candidate, that he or she won't fit in.
The human resource literature tells us that there is little if any correlation between an unstructured interview and ultimate job performance. Even structured interviews in which the interviewer asks predetermined questions has little correlation with ultimate job performance except in very special circumstances which few residency programs could meet. This would entail doing a longitudinal study of residents' answers to standardized interview questions and do statistical analysis with performance as a resident (or even better, as an independent surgeon after graduation) as the dependent variable. We also know that it is expensive to travel for these interviews and takes time away from a student's studies. It is therefore important that we make these visits informational and give the students an opportunity to ask our residents the questions they are scared to ask us.
There has recently been a healthy discussion among program directors about the interview process. It seemed to me that most directors commenting felt it was important to physically meet those applicants who, if accepted, would be spending the next 5 years with them in the operating room, the patient rooms, and the classroom. This sentiment may be difficult to overcome, even if it runs counter to the human resources literature. Perhaps there could be a two-tiered process in which institutions created a video about their program and applicants created a short video about themselves. This could be submitted via ERAS (ERAS stands for electronic residency application service and it facilitates applicants sending their information to residency programs), and only those candidates who made the first cut would need to bear the expense and time off from their studies to travel for an interview. The American Medical Association, to its credit, has decided to dedicate 15 million dollars over several years to improve residency training. They have correctly recognized that the transition from medical student to resident is an important process and one that needs to be made as seamless as possible. The interview process is one small facet of that transition and hopefully some energy and resources will be devoted to its improvement, lessening the burden on both medical student and the residency program, too.
We know anecdotally that the students are often coached on the questions to ask and the ubiquitous question is what do we, as faculty, want to see in a candidate. I often told them when I was Program and Chairman that it is not what I want to see in a candidate but what I want to see after their five years of training with us. I want to see equanimity as per Sir William Osler's essay Aequanimitas. What I want is that when they, as a surgeon (or, for some, even while still a resident) walk into a room, the patient, the family, and the other staff think thank goodness Dr. So-and-so is here; now everything is going to be all right. They are like a promontory against the sea. This is a difficult demeanor for any of us to cultivate but something for which to strive.
David Levien, MD, MBA, FACS is President and CEO of The American College of Healthcare Trustees, an organization whose mission is to promote good governance, leadership, and decision-making in healthcare. He practiced clinical surgery for 33 years, was Chairman of Surgery for 20 years which included Program Director of a Surgical Residency for 12 of those 20 years. The organization's website is www.facht.org. Dr. Levien can be reached at david.levien@facht.org.
