The Cut Line

As the name might imply, the most important part of any residency program is the residents. The exciting but also sad part of residency is that the residents are here temporarily. Residency is only a small, but formative, blip in the movie that is their medical career. Just when you really get to know them and they are starting to show their full potential, they are soaring off into the real world to practice their craft. On the plus side, behind every graduating class of residents is a class of eager, newly minted doctors, nervous, but ready to take on the new challenge of residency.

But to get that class of fresh-faced upstarts, an exhaustive and tiring process known as “interview season” needs to be endured. When it comes to interviews in pediatrics, we tend to be “softies”. We want to be nice, be thought of as nice and on the whole, don’t want to hurt people’s feelings. While these traits are great for dealing with kids and families, it is not so helpful when trying to winnow down a very large list of candidates.

When your average pediatric faculty member interviews residency candidates, if you were to have them rank each candidate on a scale of 1 to 10, you invariably get a lot 8’s and 9’s. While we do get a lot of excellent candidates (because we are awesome, naturally), not all of them are above average. (That would be the residency program at Lake Woebegone.) I am not above reproach on this subject. In previous years, when the statistics were broken down, I had an average score given of like 9.2. (In my defense, I still believe I got a skewed group of applicants that year who really were all above average.)

A family member once told me about when he would interview applicants for a job with his company, he would focus on very small details, such as eye contact. If the candidate did not make consistently good eye contact, he or she was rejected. It didn’t matter how good their resume was or how good the rest of the interview was. At first, I was kind of taken aback by that story. It seemed to be cold-hearted and mean (the “softie” in me coming out.) However, I thought a lot about that story during interview season this year.

Coming in to interview season, I was very nervous. It was my first year as an associate program director (basically, I help to steer the ship that is residency) and I knew that I would be called on to interview a great deal of the candidates. The problem was, I was going to be the sole member of the program director team that would evaluate those candidates in person. Sure they would be interviewed by a faculty member, and my boss would check out the file, but I was the one who would know them best. I didn’t want to screw that up. What if I was the guy who let some slacker in because I was charmed with the nice conversation we had about non-medical things (like the Cubs or pies)? (Mmmm, I do love pie.)

So I started out this interview season with a new resolve to really comb through the application packets and be discerning. Some of it was by keeping my uncle’s story fresh in my head and some of it remembering that I was wearing a different “hat” than I had before. In the end, I feel like I did a pretty good job and gave an honest assessment of all the applicants that I interviewed, defending the integrity of the program. Or so I thought.

The other day we had our big meeting to help the boss put together the ranking list of all of the applicants. (Or as my wife calls it, sorority rush. In many ways, she is right.) During that time I had a greater appreciation for what this process is all about. (I also once again came away from the meeting wondering how I ever made it into this program. Looking at the applicants who have all been to more interesting countries, gotten better grades, have scored better on the boards and saved more kittens from trees than I have ever done, I am amazed that I didn’t have to go to Plan B and become a tackling dummy.)

As someone who wants to be a program director someday and run a residency program, I always thought the goal was to be like a glorified bouncer, only letting the VIP’s in and keeping out the rif-raf. If you brought in residents who at some point struggled or needed remediation, you had failed. But that is horribly flawed. There are a great many talented individuals out there who would do well at any one of the hundreds of pediatric residency programs across the country. The purpose of interview season should be to identify people who would reach more of their potential and be more at home here than at other programs, so that we set them up for success.

As I was walking out of the meeting I came to another realization. If a resident struggles, it is a failure by our team, but not for the reason I thought. It is most definitely NOT because we allowed the wrong candidates past the velvet ropes. Rather, we have failed to “coach them up.” Just like a college coach who brings in a class of recruits for the upcoming season, it is nice to talk about how many “blue chippers” and “diaper dandies” there are in a class (of residents or college football players). In the end, all that really matters is what you did to help them grow and develop once they got to your program. Or in the wise words of Mr. Miyagi: “No such thing as bad student, only bad teacher.”

These revelations had the benefit (misfortune?) to replace one kind of nervousness (not picking the right applicants) with an entirely new (and more worrisome) nervousness (being a horrible teacher.) But this is the challenge that I have signed up for.

I am excited to see who matched into our program. I am excited for the opportunities and challenges that will arise for them. I look forward to seeing how they will push me to grow. I feel bittersweet about seeing another class of residents graduate. And even though the last one just ended (and most of my colleagues will think I am crazy), I can’t wait for another interview season to start.


About ironsalsa

I'm just a man who likes to hear himself talk, yet pretends he can't stand himself.
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2 Responses to The Cut Line

  1. Kevin says:

    Timely blog post, as I start a job on Tuesday where for the first time I will be in charge of interviewing and annual appraisals (and termination)… I agree with the coaching aspect, though one major difference is that when we hire someone, we hope they stay for more than 3-4 years!

    One a side note, did you see the ad that Google put at the top of the blog? “Get expert care for kids, Peyton Manning St Vincent Hospital”. Hmmmm, Google has the general topic right, but the computers have not seemed to have acquired irony logic yet…

    • ironsalsa says:

      Didn’t know you had a new job. I’m guessing it is same company new responsibilities? The Peyton Manning ad is very ironic. Then again, maybe they do know what they are doing and are trying to be ironic, testing out their new irony program, like IBM testing out Watson on Jeopardy.

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