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What Residency Program Directors Actually Want · The Short Coat (Audio): An Inside Look at Getting Into and Getting Through Medical School

• 0:00
  NA: The following is a conversation. It has the features of any conversation such as imperfectly expressed thoughts, ill considered opinions, and the notions of several sleep deprived brains. Try not to get your stethoscope in a twist about it.
• 0:11
  Dave Etler: On today's show, we're talking about what the heck program directors want from m fours applying to residency.
• 0:31
  Zach Grissom: Yeah, it is good. Good. I think it'll be an opportunity for students to get kind of more involvement in the direction of the show and really make sure that there's some like greater longevity than the 15 some years that, that you've headed it so far.
• 0:46
  Dave Etler: Yeah. That's not enough time.
• 0:47
  Zach Grissom: No.
• 0:48
  Dave Etler: You know, you never know.
• 0:49
  Zach Grissom: Yeah.
• 0:49
  Dave Etler: I
• 0:49
  Zach Grissom: could, I
• 0:49
  Dave Etler: could just disappear. I could get hit by a bus. That's my fear. I'll get hit by a bus and then the podcast will stop.
• 0:54
  Zach Grissom: Hey, those cam bus drivers are highly trained,
• 0:56
  Dave Etler: alright. They are highly trained. I don't think I need to, to worry too much about it, but you never know.
• 1:00
  Chase Larsson: You know what they say though? Free college then is
• 1:05
  Dave Etler: I have heard that. I don't know if it's true.
• 1:07
  Chase Larsson: Yeah, I don't know either. Should we try? That's, that's what it means. I'm pretty sure I did
• 1:11
  Dave Etler: get hit by a bus. No, sorry. I got hit by a van when I was, um, uh, when I was, uh, 14. And that accident paid for my college.
• 1:38
  Chase Larsson: Yeah, yeah, exactly. Exactly.
• 1:39
  Dave Etler: Anyway, I don't, I don't have a, there's a, there's a few challenges we've gotta address, um, you know. Like, like you said, I wanna get, uh, I wanna get students more involved in deciding on our content.
• 2:33
  NA: meandering in the margins of medicine. It's the Short Coat Podcast.
• 2:39
  Chase Larsson: Weird news, fresh views, helpful clues, and interviews
• 2:43
  NA: by students. For students. Subscribe to our weekly show@theshortcode.com.
• 2:55
  Dave Etler: Welcome back to the Shoko Podcast. It's a show that gives you an inside look at medical school from the students drinking from that fire hose into production of the University of Iowa Carver College of Medicine. I'm Dave Etler back after a four weeks, which is unusual hiatus. Thank you for sticking with us.
• 3:29
  Madeline Ungs: Hello.
• 3:30
  Dave Etler: And he was voted most popular emergency contact. It's M two Zach Risso. Hey, if you thought that was all poor, misguided souls couldn't have been more wrong 'cause we're joined by a former co-host 2022 grad of the Carver College of Medicine. As of just recently, family medicine, fully fledged, honest to God, attending physician Dr.
• 3:55
  Teneme Konne: Welcome back. Good to be here. Welcome back. Love to hear that, Dave.
• 3:58
  Dave Etler: Yeah. Uh, our show today, as I said, is about the uncertainties of applying to residency, and it's from an anonymous listener. I have decided to call baffle Jay, who's a daddy. Um, he's a father of two who will both be m fours this year.
• 4:23
  NA: first. Absolutely love the podcast. I am a father of twins, both of whom are rising m fours. They put me onto your podcast four years ago and they and I have been faithful listeners while they both attend different medical schools.
• 5:39
  Dave Etler: There's something I wanna say about this question. It feels important to me, and I hope listeners will, um, listen, take heed. How about that?
• 8:08
  Madeline Ungs: Yeah, a little bit. Uh, there's definitely differing advice out there and it can be hard to know where to start sometimes, but I feel like I have a little better handle on it now.
• 8:21
  Dave Etler: Yeah. Some of it, some of the mystery of it and some of the reasons you get different advice is because we don't actually have a lot of data about mm-hmm. What program directors want. Um, so the tradition, some of the traditional ME metrics, um, that program directors relied upon have disappeared over the years.
• 8:50
  Teneme Konne: I, I, I had a score on my, step one wasn't very high, but I passed.
• 8:54
  Dave Etler: Okay. Beautiful. Um, preclinical courses, a lot of those, um, at many schools have gone pass fail in the name of sort of taking the pressure off. Students. Um,
• 9:05
  Zach Grissom: interestingly though, places have honors and near honors, which are an A, a B, and A pass is a C.
• 9:15
  Dave Etler: like in our case, some courses have, uh, grades and some courses are pass fail or Yeah. Or true pass fail. Um, and step two Cs, clinical skills that left us. Um, I think, right? Yeah. Mm-hmm. Mm-hmm. CS that's gone. Um, so the pressure has sort of shifted from these, you know, quote unquote objective numbers and measures to sort of CV building and that risks being performative, uh, rather than genuine.
• 9:48
  NA: Mm-hmm.
• 9:49
  Dave Etler: Um, so students do more research, they do more activities, um, they do service and not always out of passion. Um, but because they feel like they have a box that they need to check. And so programs face noisy data, they have vague signals of, of, of excellence. At least that's how they feel about it.
• 10:25
  Chase Larsson: Yeah, for sure. Yeah. I mean, yeah, obviously. I mean, I, I feel like definitely I'm, I'm, I'm definitely worried, but there's like you said, like kind of at, just like at the start, like just starting to build that story from day one, I feel like is so critical because, I mean, the rat race that we're in at this point, I mean, it is all just kind of, uh, it's, it's difficult with like all the little things that you have to do to try and.
• 11:24
  Zach Grissom: talking of raising the passing Right, right. By a couple points. Yeah, yeah, yeah.
• 11:38
  Dave Etler: The shifting sands of, of, uh. Of, uh, scores, I guess. Um, what about you, Madeline, you, any, any, any concerns about, uh, about this that you wanna talk about?
• 11:53
  Madeline Ungs: You don't have to.
• 12:15
  Dave Etler: quality over quantity.
• 12:16
  Madeline Ungs: Yeah. Mm-hmm. And I, that definitely comes across in my application. And, um, for my, I mean, I know for my specialty I'm applying to, they really put an emphasis on the whole person and like how, what you bring and what passion you bring, and they really look holistically. Yeah. Mm-hmm.
• 12:35
  Dave Etler: When you applied. Um, how did you try to stand out and do, do you think it worked?
• 12:42
  Teneme Konne: I think I tried to kind of, I mean, I was kinda like Madeline when I went through medical school I was very, like, I didn't do a whole lot of stuff. The stuff that I did, I took seriously. And when I talked about that during my interviews, I felt like that was a way for me to connect with my interviewer, because people can tell when you're talking to them if your heart is in the words that you say and if it's not, and how much of your heart is in those words.
• 13:30
  NA: Yeah.
• 13:30
  Teneme Konne: It looks like you, it walks like you, it talks like you, but it's not you. There is no substance to it. You are what creates the shadow, not the other way around. And so I think what folks need to keep in mind is don't worry about starting your story in medical school.
• 14:56
  NA: Yeah.
• 14:56
  Teneme Konne: If, if, if you know the answers to those questions, everything else is secondary.
• 15:03
  Dave Etler: So I sent you guys some stuff mm-hmm. Before the show, um, some graphs. Mm-hmm. So the, one of the, one of the data points that, that we. As a school have is the National Residency Program Director Survey, is that right?
• 15:41
  Chase Larsson: I think, I think it kind of just speaks to what was just saying, like with, for getting chosen for an interview, at least they're not looking for like something to like super jump out at them.
• 16:38
  Dave Etler: Yeah. So, uh, talking about what programs actually prioritize, um, academic performance obviously is foundational, that said, yeah, like you said, demonstrated professionalism.
• 17:29
  Teneme Konne: I'm not gonna say resilience, but I, I said that we've all had sunshine, rain, yes. Trauma strife. But what, what has brought you through that is your identity.
• 17:50
  Dave Etler: They want. Yeah. And they want, um, they want some indication that you can be a leader. Um, because yes, as you progress through residency, you will become a leader.
• 18:21
  Madeline Ungs: Yes. I was so excited when I saw that
• 18:23
  Dave Etler: because you're going into ips.
• 18:38
  Madeline Ungs: Yeah, that makes sense to me.
• 18:40
  Dave Etler: Um, for psychiatry. The other, uh, the, the other child of Mr. Mr. Who's a daddy. I'm, you know, it's been four weeks. I, I'm having trouble getting back into my podcast persona.
• 19:35
  Zach Grissom: Yeah, I, I know it's, you know, I haven't asked for residency letters yet, obviously, but, um, some of the ones that I asked for medical school re recommendations, asked to get like my, my CV for me to basically talk about some stuff and what, what, if anything out of there, um, they wanted me, um, wanted.
• 20:42
  Dave Etler: Um, make sure that your personal statement addresses your strengths, obviously in, in the areas that program directors, uh, are really interested in.
• 21:11
  Chase Larsson: I also just wanna say, I think this is like kind of commonly, like well known at this point.
• 22:02
  Madeline Ungs: Yeah, I'd agree with that. I'd say if you don't have a really clear, good weakness, just don't. Just don't address weaknesses.
• 22:11
  Dave Etler: Yeah. I mean you're, yeah. So, um, I think you wanna also like, think about how you act during your clerkships. So you just make sure that you act like the physician that they want during your clerkships, a committed, ethical, self-sufficient humanist that people want to work with. Mm-hmm. You, uh, you giggled.
• 22:34
  Teneme Konne: Yeah. I mean, it just, it, it sounds so performative when you put it that way, Dave. I know. I know. Perform. Damn you.
• 22:41
  Dave Etler: I know, but I, I feel like I, I feel like when I say that, a
• 22:46
  Teneme Konne: lot of you are already there.
• 22:47
  NA: Mm-hmm.
• 22:48
  Teneme Konne: And I think a lot of those people will just do naturally. Like there's a reason you wanted to be a doctor.
• 23:29
  Dave Etler: I do worry though that sometimes medical students might not feel like the committed, ethical, self-sufficient humanist that people wanna work with all the time.
• 24:17
  Teneme Konne: work. I guess I can, I can kind of give some insights here because I was just a resident and every year we had to, like, as the residents at the residency program, we would look at all the applicants that were coming in and then I guess I'll kind of say what we did at our program.
• 26:54
  Madeline Ungs: that.
• 26:56
  Teneme Konne: So, let's,
• 26:57
  Dave Etler: Madeline is an introvert
• 26:58
  Teneme Konne: and so, and so, I, I kind of gave some pushback 'cause as a fellow introvert I could tell that, you know, they said a lot of good stuff.
• 27:16
  Dave Etler: I, uh, I help write the MSPs and I do occasionally see somebody who comments, uh, they're too quiet.
• 27:27
  Teneme Konne: I'm like, come on, please stop.
• 27:29
  Dave Etler: school, I know, and I, I kind of get it. Come on In a way, I do, I do. I kind get it because it's hard, it's hard to evaluate somebody who, um, doesn't yap. It doesn't give you it,
• 27:42
  Teneme Konne: it is hard. So I would say for all, for all of my introverts, that is, that is the one performance you may have to engage in.
• 28:01
  Dave Etler: yeah, Madeline, that's just part of the
• 28:03
  Teneme Konne: game, I suppose, as an introvert. Have
• 28:05
  Dave Etler: you, have you felt this, uh, sort of pressure before or, or no.
• 28:09
  Teneme Konne: But yeah. Oh, sorry.
• 28:11
  Madeline Ungs: Oh, that's okay. Yes. Uh, and I just, you know, had to,
• 28:17
  Dave Etler: I mean, what are you gonna do?
• 28:19
  Madeline Ungs: I mean, yeah, you, you, it's kind of like a performance a little bit. You just do a little more talking than maybe you'd want to, but it starts to become a little easier and, and I still always felt like myself.
• 28:35
  Zach Grissom: So, uh, a question, do you think that that's. More of, uh, interpersonal assessment or like a professional communication as assessment. Um, because if you're, go, go ahead.
• 28:47
  Teneme Konne: Yeah. I think in regards to like the introvert not, not talking a lot, a lot of times that's more of like an interpersonal thing.
• 29:06
  Zach Grissom: different if they weren't able. To speak up when it was their turn, like in a patient room or something.
• 29:17
  Teneme Konne: Yes. Yeah. I, that, that, that's a good point. And I think for most people, when we're in work mode, we do kind of like adopt that professional persona. Like we, we, we mm-hmm. We kind of leave a part of our solves a bit in the back when we're being doctors, right.
• 29:32
  Dave Etler: yeah. I, um, even I, when I go home. I'm much less of a yapper than I am all yapped than I am. I'm all yapped out by the end of the day. You know, my wife sometimes is like, can you respond to the thing that I just said? I'm like, oh, I thought I did. I did. In my head,
• 29:50
  Chase Larsson: the, the advice that I've gotten from like some residents and obviously tenement, you can speak better to this is, um.
• 30:34
  Dave Etler: they're
• 30:35
  Chase Larsson: gonna come for you. Yeah, I know, right? Yeah.
• 30:42
  Teneme Konne: Yeah. Um, I think that's true. Um, I think the context is a little bit more general than that. Not necessarily 3:00 AM but what residents really care about is. If this resident comes here, would that make me happy? Would that make this program better?
• 31:05
  NA: Mm-hmm.
• 31:06
  Teneme Konne: Right. So, um, that's what they're looking for, right? Because when you go to a residency program, yeah, you're going there, but also they're kind of bringing you into their like ecosystem and so they, they have anxiety about.
• 31:58
  Chase Larsson: Yeah. Yeah. It's important. I think it's really important. And if you
• 32:01
  Teneme Konne: can fit into like their culture fit in, and if the residents feel like, Hey, this someone I could, you know, ask a question to someone that is a hard worker or someone that is self-driven, those are all things that are gonna make them want to say yes to you as an applicant
• 32:16
  Dave Etler: and somebody that you can rely upon to help you when you need it.
• 32:19
  Teneme Konne: Mm-hmm.
• 32:19
  Chase Larsson: Yeah, exactly.
• 32:21
  Dave Etler: Anyway, chase,
• 32:22
  Chase Larsson: I think it, like, the way I've heard it is like you're gonna be spending, like, as residents, you're gonna be spending so much time together whether you want to or not, like whether you want to or not. And obviously you're gonna want to have, want to spend a lot of time with them.
• 32:37
  NA: yeah,
• 32:37
  Chase Larsson: they're gonna choose someone who they like. Which,
• 32:41
  Dave Etler: which brings me back, which brings us back, I think, a little bit to the idea of being yourself. Um. I know that a couple of times I've said, you know, well there's a performative aspect to, to all of this. Um, but the, but think about, um, being yourself as a way to weed out programs that you don't
• 33:01
  NA: fit
• 33:02
  Dave Etler: with.
• 33:20
  Zach Grissom: Yeah. The, the performance of it is to me in some ways, like how certain actors are just themselves in every MO movie, but like that that works.
• 34:26
  Dave Etler: this came up
• 34:26
  Zach Grissom: and, and it came, came up and, and like briefly talked about one that I hadn't read that one of the interviewers like. Have you heard of it? This one? I'm like, no, no. And talked about some and what value I got out of them.
• 35:51
  Madeline Ungs: this brings me back to a point, sort of from earlier, but this whole thing about like being yourself some. Um, some advice I got for the personal statement was, is this something that just anybody else could write or is this something that is unique to you? Hmm. And I feel like that goes for both personal statement and the interview when you're thinking about answering questions or writing, when you're writing your statement.
• 36:22
  Dave Etler: I'm glad you brought that up. I kind of forgot about it. I, but I wanted to talk about that. Um. One of the mistakes that I think, uh, Camille, uh, who's the director of the writing and humanities program, um, who is helping students right now review their personal statements.
• 39:01
  Madeline Ungs: do not have signals. You guys don't have signals?
• 39:03
  Dave Etler: Okay. Um, other programs have. Special signals that you can
• 39:10
  Zach Grissom: use. I believe OB gyn has like gold and silver. Yeah, gold and silver signals.
• 39:14
  Chase Larsson: I, I saw that. I just learned about that yesterday. Yeah. When you sent that thing out. I think it was just regular. Im, and it said like three gold signals and 10 silver signals.
• 39:37
  Dave Etler: it, I know when I first heard about signaling, I was like, well, how are you supposed to signal a program that you've, that you don't know about?
• 39:45
  Chase Larsson: Yeah.
• 39:45
  Dave Etler: You know? But I think the idea is, is to signal programs that you just want to talk with them. Mm-hmm. You know that they are on your, on the top of your list. Yeah.
• 39:56
  Teneme Konne: Um, typically how we have kind of looked at it from the residency side. Part of the tent is that if you signal we're like that kind of, that kind of like perks up our ears, perks up our eyes, and we definitely take a, a good look at you.
• 41:41
  Dave Etler: Uh, there's a also, yeah, you, you mentioned geography as, uh. As one kind of signal. Are they separate signals?
• 41:50
  Teneme Konne: No, no, it's not a separate signal. It's just, um, they, they, like, they would signal to us and then like something in their application would kind of speak to that. Mm-hmm.
• 41:59
  NA: Yeah.
• 41:59
  Teneme Konne: Right. I
• 42:00
  Madeline Ungs: think is the question statement.
• 42:01
  Teneme Konne: They said like, oh, I have passion to, you know, work back home in Nashville and then they signal the program and so we kind of draw that connection there.
• 42:11
  Madeline Ungs: There's also geographic preferences and that's a separate, maybe that's what I'm talking about. That's a separate thing from signaling. Yeah.
• 42:16
  Zach Grissom: And then if you like get into the, the weeds, like, I don't know what signals work like for like urology that goes through an entirely separate, like earlier match process as well.
• 44:06
  Dave Etler: Um, yeah. So to, to sum up signals, um, 92% of programs reported using signals to help decide who to invite for an interview.
• 45:06
  Madeline Ungs: Med peds is sort of like that, even though it's the, one of the bigger combined residencies. There's almost 80 programs. They're still pretty geographically,
• 45:16
  Dave Etler: like Yeah, I would assume they're like mostly in, um, clustered. Yeah, they're mostly in cities.
• 45:24
  Madeline Ungs: So I've watched some webinars, um, where PDs kind of talk about what's important and they've said. Geographic preferences, not so much since most of our programs are in the same areas anyway. Yeah.
• 45:35
  Dave Etler: And they're most effective when combined with program signals, so.
• 45:37
  Madeline Ungs: Mm-hmm.
• 45:38
  Dave Etler: Mm-hmm. Um, I think, let's see, 40, we're at 47. Um, so ambiguity, I, I want to give you some takeaways from, from my, my research. You guys can chime in if you feel that they're. Wrong or that you have additions to make. Um, ambiguity is baked into the system now. Um, but you can still be strategic. You can still be authentic, um, in your application.
• 46:55
  Zach Grissom: Yeah. You utilize like alumni relations for people who matched into that specialty too. Like if you don't know someone from a class or two ahead of you that matched in there, like talked to your school about getting in contact with them 'cause like they just did, did it, and that they might have more frank advice about that specialty than what you'll get from.
• 47:25
  Dave Etler: we mentioned contradictory advice before. Mm-hmm. Unfortunately, that's a fact of life. Um, it is confusing sometimes to get, uh, conflicting advice. I don't know how to fix that. I don't know how to help you with that other than to say that, you know, put it all in the hopper and then make your own decision about it.
• 48:13
  NA: The residency match process is really unlike any other job interview or hiring process that I'm aware of, and I can see how signals may make this even more confusing. From my understanding, signals were instituted to help programs and applicants in a mutually beneficial way.
• 49:23
  Dave Etler: Thanks, Dr. Schmitz. Um, so that's our show, uh, doctor. Ma what is next for you?
• 49:33
  Teneme Konne: Um, I'll be heading to Missouri. Got a nice job out there.
• 49:37
  NA: Awesome.
• 49:38
  Dave Etler: Missouri.
• 49:39
  Teneme Konne: Missouri. I'll be, I'll be about, uh, 30 minutes from Kansas City being, being a St. Joseph's, so I'm really happy to start there. It's gonna be great. Excellent.
• 49:47
  Dave Etler: Wonderful. Awesome. Congratulations on finishing your residency. Thank So it's a, it
• 49:51
  Teneme Konne: feels so, I mean, wait till you guys, if you think getting into medical school is good, if you think getting out is good, wait till you get outta residency. That is the best feeling. You, you'll feel probably for a while.
• 50:05
  Zach Grissom: Then it's fellowship for some still and then what and and then his fellowship for some, yeah.
• 50:10
  Teneme Konne: Oh yeah. Well,
• 50:12
  Zach Grissom: that's
• 50:12
  Dave Etler: their choice. That's your choice. Uh, chase, Madeline, Zach, thanks for hanging out with us today. Yeah,
• 50:20
  Madeline Ungs: thank you.
• 50:20
  Dave Etler: And how confusing would it be if I didn't? Thank you short coats for making us a part of your week.
• 50:25
  Hi, short coats. Look, life in medical education, life in America, life in the world is often difficult, and I often wish I could help. All I have is this podcast, but in my wildest dreams, you have the support you need to lead a life of your choosing. You deserve to be happy, healthy, and successful in whatever ways you define those words. So if you need support because you've experienced. Racism, discrimination, harassment, mental health crises. I want you to be able to get the help that you need, and so I'm gonna put some links in the show notes to some resources that you can use. But the bottom line is that for what it's worth, I see you. I know you're out there. I wish I could do more. Maybe I can in ways that I don't understand yet or know about, but I see you and I'm glad you're here and other people are too. The Short Code Podcast is a proud member of the MedEd Media Network. Inspiration, information, and guidance on your journey to medical school and beyond@mededmedia.com.