“Look at every path closely and deliberately, then ask ourselves this crucial question: Does this path have a heart? If it does, then the path is good. If it doesn't, it is of no use.” ~Carlos Castaneda

Friday, February 2, 2007

The rank list - a scientific process?

I sit here in my office thinking about the resident applicants that I am about to interview tomorrow, and I realize that this really is not a very scientific process. We have to go through and interview a number of applicants. Everyone sits down in a room and goes back and forth and tried to remember the people form weeks ago. We go back and forth who we like and who we didn't like. I actually think placing people at the bottom is the easiest part of the whole process. Those people that give you the willies are easy to spot, and it is usually a consensus thumbs down. The middle section is extremely difficult, and the top, sometimes, even more difficult.

At our institution, we review all of the applications to select those who we will interview. We split them into 2 piles, and 2 faculty members review half and the other 2 faculty members review the other half. Then we rank the applicants from 1 to whatever. Unlike some institutions, we actually read the applications first and offer interviews based on what we see. Now that is not very scientific. There is no exact formula; no cutoff by board scores. It comes from a gut feeling. Now understand that we don't have 500 applicants to review. We have a 6 year program, which deters some from applying. Most large programs and programs in more desirable cities have a larger number of applicants and therefore use some way of "screening". For most, the USMLE score is probably use in some way shape or form (e.g. cutoff). Smaller programs, like ours, are more likely to look at other factors like where you are from, the school you attend, your aspirations, where you rotated for AI's. These "other" factors come into play.

I sit here trying to think of what factors I am looking for once we have selected you for an interview. What makes me want to choose you? I guess it comes down to a number of things. We are all shaped by our own experiences. We tend to be drawn to things for different reasons. May be it is your alma mater; or may be we know the person who wrote your recommendation; or may be your personal statement brought to light something that is not evident in you application, something that is unique to you. The interview for most is a snapshot of who you are. I guess for me, I can't speak for anyone else, it is a gut feeling. As an attending, I have to trust you, I need to like you, I need to know that you will be a good representative of me to my patients, as well as, a good representative of our program. So we are shaped by our experiences. Bad previous residents or experiences may cloud our judgment of you (not something you can prepare for). If you come unprepared to the interview (don't know your CV or research, don't know about the program, and don’t have answers to the simple questions like why you are going into orthopaedics), I wonder is this how you will be when you enter the program. So, I guess what I would advise be yourself, know who you are, know your strengths and weaknesses, and some how bring that to the interviewers attention. You need to be able to be your own spin doctor.

So, needless to say the whole rank list comes basically out of some gut feelings. People that make us feel like you will be a good representative of our program. I personally feel that the people that I help train are somewhat a representative of me and our program. When they go onto fellowship, into practice, and present at meetings, I want to be like a proud parent and say that was one of ours.

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