Virtual Interviews: Residency Applications (Part 2)

Charles Goldfarb 0:16
All right. Welcome back, we're here to talk more about the resident application and interview and virtual processes. And hopefully you enjoyed the first segment of this with our special guest Cassandra Lee, but we're not going to let her off with just one episode. We're back for more. Welcome back.
 You know, it’s interesting, I have a high school senior applying to college and she got her essay done. And she's like, “Alright. I'm ready to go. I'm done.” And then she sees, she’s applying early to one particular school, and there's like eight other essays or questions that she's got to answer. And so, I know that's been a topic of discussion for our application process. And I understand the rationale in doing it. I also understand the rationale and avoiding it. So, what are your thoughts, Cassandra first and then maybe Alexander.
 
Cassandra Lee 01:05
Yeah, I think that's an interesting concept of having a secondary application, if you will, something that really sets you apart. Because of this, you're not having the ability to have actual in person acting internships, we don't get to know the applicant we don't know how truly interested they are we don't know anything about them except just what shows up on paper. So, getting that secondary application in there, you can absolutely see the reason why. L, we really want to get to know you. The other part is like, yes as a personal statement, you have your letters of rec, but after you go through about 1000 of them they kind of look fairly similar after a while. So, just trying to figure out how to make this applicant look different. Why would you really choose me to come over to UC Davis versus like Wash U? What is the difference? And so I can see why you would want to have an extra application. That being said, in that one-month period. Now that we have from October 22 to November whatever the date is, am I going to be able to read that many more personal statements? Not multiple choice, it's not a multiple choice answer test. So can I grade all these papers and get my rank list ready? And so I don't know I think we, I know as our program we definitely talked about it, but that's not something we're actually implementing.
 
Alexander Aleem 02:17
Yeah, I think when this first came, we were really like, “That's a great idea because it's going to help distinguish the people that really want to come to a program versus another.” And then reasons you mentioned. Is a class is going to be a whole lot more to review? And then on the flip side, for the students, I don’t know how many programs they are going to apply to,but all 70-80 programs that they apply to now require an extra essay or video or something. They're not going to do that. That's going to be it's going to be way too much. And so that was kind of our discussion as well was like you know the application process on both sides is going to be incredibly daunting. Let's not try to add anything. There has been some discussion about ENT is doing this token system, where they're allowing students to sort of give five tokens or kind of, or five roses if you're a Bachelor fan, to the programs of their interest. I know, CORD came out with a statement saying that they will not support that. Can you speak a little bit about sort of how that discussion went?
 
Cassandra Lee 03:19
Yeah, so I think this discussion came about between ENT, I thought it was urology, I couldn't remember exactly where this came from. The idea was that a company was actually going to come up with this concept of a token and then so that there are a signal. I think it was actually called a signal. I think in other industries, you could actually signal and say like, “Hey, this is what allows me to be interested.” So, if you think in effect also your AI, you know, traditionally, the acting internship was kind of like a signal, right, because this is your ability to show that I'm really interested in program. I'm going to commit for weeks to come and actually learn about you. So now that that's out of the out of the equation. So now the question is, how is that student going to stand out? How will you know that I'm interested, that we're just in your program?
 So I think the idea we talked about with CORD was that this was something that was certainly in its infancy. It was really early on. It was a program that had even gotten their act together, but they came up with kind of the idea, but not necessarily kind of the details. And we know always, the devil is in the details. So, it certainly sounds also monetary. Like in terms of, well if you have five signals and you can pay X amount to this company, and they’ll put your signal out. So it's one of those well, potentially in the future we can think about it but as of right now as it stands, this was nowhere near being ready at the time we want it to be ready. So that's why we came out against it.
 
Charles Goldfarb 4:48
Right. Super tricky. Should we pivot a little bit and talk about this from a student perspective? Certainly, I think everything we've said so far is recognition of the difficulty on us. But the difficulty for students is clear as well. Do you think students will, or should apply to more programs than ever? Any, any advice on for students listening about the concept of how many programs to apply to?
 
Cassandra Lee 05:16
It's hard to empathically tell myself to be a student say, “Yes. Go ahead and apply to more programs.” just from the standpoint of the program director. Because unfortunately, it gets lost in the shuffle. So, I think if you look at the AAMC numbers, and there was a nice slide that one of the speakers showed at the town hall, was looking at kind of breakdown of, you know where your board scores are and where your number of places you should apply to. And roughly it was, it was kind of a nice kind of setup. But reality as we know that it's not uncommon for students to apply to 80 programs. 
 But, I think looking at the AAMC numbers, I think they said they broke it down to if your Step 1 scores are above 247 you can apply to anywhere from 26 to 36 programs, on average 30 programs. If your board scores are a little bit lower, 235 to 246, you are looking at 31 to 45 programs, with an average number of 38 programs. Anything below 235, you are looking at 49 to 63 programs with an average of about 56 programs that you are applying to.
 So that was kind if you look at all the numbers of how things work with the AAMC that’s what came out. But I think the reality is, I think this is where it is really important as a student to get to know your program director. Make sure they know who you are, what you are about. Hopefully you are not just know jumping in, trying to say, “Hey, I’m interested in orthopaedics.” Hopefully, you’ve working on this relationship for a while. Because the reality is, I think, I don’t know, maybe this is what I personally think. A lot of times, when students are interested in programs, I mean, how many emails do you get, Alexander, saying, “So and so is interested in your program. Do you guys want to take a look?” And as a professional courtesy I will absolutely pull this application and look at it, put it through what we would normally look at in an application. And if it looks like it fits, then it is in our maybe pile, or maybe it’s a, “Oh, yeah. We missed this. This is a great applicant.” So, I think a lot of this is still hits upon relationships. So, I think this is where the students should get to know their program so that when it comes to it, someone can go to bat for you and really make you stand out.
 
Alexander Aleem 07:35
That image that was shown was really telling because I think it was even in the in the sort of lower tier lower board score students, their sort of number of programs is diminishing returns was 20 less than what the average orthopaedic student applies to and is because they've got this…there's this fear that if they don't apply broadly they're not going to get the number of interviews and everyone else is doing it. And when you talk to your classmate, they're applying to 90 and so you feel like you can't and. And it's hard because you know, as program directors we try to try to advise to that but then they're still getting all this other information. And I think this year it's even more so just well I have no way of showing these programs that at least the fears I have no way of showing this program. So, I should just apply everywhere but I think your point about take the advantage of the fact that you're going to probably spend more time at your home program to really get to know a lot of people who know people that are the programs. Because that's what that's going to be huge. I think the connections, the emails the phone calls that we get during the review process from people that we know. And, you know, our students for example are probably spend two or three more months than they normally would with us. And so they have an opportunity that's what we've tried to try to tell them like take this advantage so everybody can from, you know, from chair all the way down to inter. You want to be able to have multiple people go to bat for you.
 
Charles Goldfarb 8:56
Yeah, that's so true. I mean some of the traditional measures, such as letters of recommendation are more important than ever. Even if the interaction that we're currently having with those same students is awkward, is different than I've had. Even the interactions I have with the students at my university are different than they are in years past. And so trying to develop that same relationship and getting to know the Washington University students in person is harder yet my letter becomes more important. So just really challenging. And I agree emphasizing to the student that just making yourself known at your home institution is just a primary really critical step.
 
Alexander Aleem 09:34
Program applications is one. I think the number that went around when I was applying 10 years ago was you know once you get 10 interviews, that's the magic number because then your chances of matching increases exponentially. And I don't know if that's still kind of the number. Does that number change now that we tell students are we still shooting for about 10 interviews, or because, as we talked about they have the ability to, interview multiple places, maybe you should interview and shoot for a target number of 15 to 20? What do you think?
 
Cassandra Lee 10:06
Yeah, I think it's just an odds game. So if you get to the point of 10, I think the number is actually a little bit higher, but not much.
 I mean, I feel like, geez I interviewed 20 years ago. Am I that much older than you? Yes, I am. But I think that was the same number we were given back then. It was like if you get to that magic number of eight, eight to 10, like that's where that's where you're going to match. So you were 10 years ago now so time in the 10 to 12 range at this point, you know something just a little bit above 10 but the odds are with you at that point.
 
Charles Goldfarb 10:36
Yeah, it's interesting, there's a learning curve for everything, and we're all, and that's programs and applicants, are going to be figuring this out. And there certainly will be a skill set developed, you know, so you know the earlier interviews may be a little rougher, and then the students and the programs will get better at it. But my gosh, I mean the key to me is you can only do a number of interviews that will allow you to be sharp. nd that brings up the question of doing two different programs on a single day and while it's certainly possible and certain people can pull it off. Others will have trouble being alert and attentive and projecting their best self, with a full day of Zoom I mean, my god.
 
Cassandra Lee 11:20
I think the other part of this is we talked about is how important the relationship is to be with your own home program. Especially for the students is that we hope that, and we actually encourage programs to actually interview your own. Maybe, whether that be on the same day you interview everyone else so then the same pool, or do you interview your home program folks on a different day, almost to kind of give them a good practice run of, ‘Hey this is how you're supposed to interview.” I mean I think that might be a good thing to do. But again, that is you're asking more of your own faculty, you're asking more of your own program, but that will potentially give a better shot to your applicants from your program because they'll have a kind of practice run. 
 
Alexander Aleem 12:02
Yeah, I think the practice run is going to be huge. And I think a lot of schools are offering this kind of, you know, just so you can get used to framing yourself in the screen, making sure you don't like jiggle the laptop. I remember, we're talking about one of the virtual interviews. And it is by no fault of their own, but an applicant had their laptop on their lap. And it was incredibly hard to focus and again he was a very like I am a very active talker and he was just kind of moving around and it was a lot. I got a little seasick. But those kind of really important. What about what about interview coaching? I think this is a great, you know, we all recognize students in person that we know probably need a little interview coaching. Those are students that are probably going to be even more to disadvantage through a virtual interview. How does that conversation change? Because there's even students that would maybe good in an in person interview that are not going to be good at virtual interviews, the ones that you may not think we would have problems. Any tips about coaching for virtual interviews?
 
Cassandra Lee 13:02
That is a really interesting question. I don't even know if there's any resources at my medical school for students to actually have a little coaching. I know there's professional development things for our residents actually. I think we actually have a professional development officer; I think for it within our GME. And they just sent out these great handouts to all of our PG4s, that saying like, “Hey this is how you guys interview for your fellowship interview.” So certainly they're prepping our house staff but I don't, I have not seen any movement to do that for our medical students. And I think maybe it's incumbent upon us as in our programs or Program Directors or APDs to identify your own student your own applicants and be like, “Hey let's do one, let's do a dry run.” And actually try to go through it. And actually walk them through an interview and say, “This is how you need to prepare. This is kind of what you need to do. You need to have a nice background. You need to be somewhere quiet.” With me, this is always my Zoom. I always put my green plant right here so it's a little bit of a point of interest. So, anyways.
 
Charles Goldfarb 14:01
Yeah, when we first started Zooming I spent a lot of time on mine getting, you know, there's all these articles about how to look good on Zoom what to do, what not to do lighting etc. And I think it goes without saying that we should do that. But I think the point is a great one. The coaching about interviews and Zoom interviews. But I would also flip it around that, you know, I could probably use some coaching a lot of my partners could use some coaching so the flip side is true as well. I think both parties are going to have to be patient and you really look for content and character, not how good we look on Zoom.
Cassandra Lee 14:35
I actually didn’t think about that. Actually, that might be something we actually need to run our faculty through if we're going to make them go through 24 interviews and up in a day. That's a great point.
 
Charles Goldfarb 14:46
No,  don't take anything from that, Alex. You don't need to put us through a multiple day rigorous…
 
Alexander Aleem 14:52
I've already have already set the wheels in motion. Got a two-day seminar coming up, so get ready.
 Maybe let’s talk a little bit, we kind of mentioned at the beginning, a holistic review process and I think a lot of programs are, we're already thinking about this and I think with probably part of the framework of step one scores, becoming pass fail, we don't have sort of our easy button to filter out students. And I think COVID has made us even more. Try to get a holistic review. Talk about sort of what your process is and so the changes that your program is made even before the pandemic and now to really make it a holistic process.
 
Cassandra Lee 15:34
I think traditionally before we actually had kind of a scoring rubric that was something that had actually been vetted out in the literature. So we kind of utilize that for years and years. And then with a new chairman coming on board to test the our APD to try to do something different. And the interesting part is like our university is, as I'm sure many universities, have been so forward and aggressive about, including and expanding diversity. Making sure that our workforce, certainly looks like the worker, the patients that we do take care of. So I think with all the diversity initiatives within our university we certainly knew that we had to start looking into adding diversity because I mean our department is probably one of the least diverse in our university. 
 So I think when we looked at that we, you know, obviously orthopaedics we still, you can't discount the academic part of it. You still know that you have to be able take tests. You still know that you have to take in information and kind of and do well with that information. So, I think for us we still have those parts of that AOA thing, but understand that not all schools have AOA. We look at clerkship score and we look at publications we look at, you know, what medical school you're at, like how well are you doing your medical school, that kind of thing. 
 But then I think the, you know, the harder part is your kind of subjective domains. So this is where you know your personality can come out in your personal statement, and your letters of rec. And I think this is why it's important that as faculty we should actually you know really pay attention to what we're saying in letters of rec as opposed to just checking the box and saying like great student. Good job. You know that's not helpful. This is not, this doesn’t give us a flavor of who that applicant is and then. So, but I think that's where we try to get gathered from that information looking at, you know, the intangibles what you, what you think is what makes a good resident. What makes a good position? you Are they able to play work well in a team? Do they show initiative to show any leadership? Do they show self motivation? What kind of values do they have? And I think that's what we're really looking through our applications this past year. And I think overall we ended up ranking, I guess within our matching fairly high and our rank list. A little bit higher than we normally did. So I think, you know, we have one year of data, so I mean the whole point is like we're going to look through this and, objectively measure like is this the right thing to do. So in the next five years that's our hope so. The nice part was we've just happened to be doing that anyway last year and I think that would be something that will, we'll continue on for this year.
 
Charles Goldfarb 18:11
Alexander, anything to add as far as what Washington University might be doing differently for a more holistic approach?
 
Alexander Aleem 18:19
And I think Cassandra really talks about a lot of things that we think about, too. I think it's, you know, the scores and the clerkship grades and the AOA. Those are all things that we're going to look at. But we realize that more and more schools are going to pass/fail, more and more schools have are eliminating their AOA chapters. So we're almost kind of forced to look at some of the other things that may take a little bit more time and it really is looking for the character and the values. And really sort of trying to parse out, you know, what are the things that make this person, that person. 
 And I think the other thing is one of the most common questions I always get asked is you know what kind of resident are you looking for and my answer is always, “I don't have a cookie cutter resident” because that would make our residency program boring. We want, we look for diversity in everything with our residents. And they're going to be extroverted people introverted people. There's going to be, you know, really organized people there's going to be a little bit more disheveled people. Whatever. But we want to have that. 
 And so trying to get into that is hard. The letters of recommendation I think, really, if they're well thought out and they really do a good job painting a picture of a person, they can be incredibly invaluable to do that. Looking at experiences, other than research I think is also important. So, volunteerism is a really big thing for me. 
 And I think as Cassandra mentioned a lot of the diversity and inclusion initiatives a lot of universities already incorporating makes that easy for us to include as well. Orthopaedics as we know is severely lagging behind nationally when it comes to diversity amongst its residents. So, those are all things that we're thinking about as well. 
 We had some ideas last year and we actually had kind of a similar experience that we ended up with a very strong applicant pool and got comments about how this is one of the best applicant pools that we'd interviewed in a while. Then we actually is very similarly ranked, and matched fairly high in our rank list and so we were like wow this is maybe really worth going into. And so again we're just going to keep, keep kind of moving forward with that but it's, I think we, we know that we have to do it, it just it becomes harder it's way easier to plug in numbers and say you know you have to have a 240, and you have to have AOA, and you have to have all honors, and you get, you'll get the number of people that you want to get. But getting into that more holistic approach it makes, I think the application process more fun. It gives you a better group to choose from.
 
Charles Goldfarb 20:45
Yeah, that makes all the sense in the world. I think we're winding down a little bit, but I want to circle back to where one of the early points Cassandra made which is regarding diversity initiatives and you mentioned that UC Davis has a university diversity, kind of open house, What’s your thoughts? Is this process going to make it more challenging, or perhaps even more straightforward to increase diversity within your program or within orthopaedics? Any thoughts or any general trends that you've heard about that concept?
 
Cassandra Lee 21:16
I know initially when we started off on this, I think in general we were concerned that there's certain applicants specifically maybe diversity and inclusion types of initiatives that might get lost in the system, get lost in the shuffle. But I think of anything, I think with such an emphasis of my university, and really having that open house it seemed really successful actually. Like it almost seems like it's easier this year to really push toward any diversity and inclusion initiatives.
 I don't know if it just happens to be that's just what I'm seeing, but I think the atypical applicant, or the diverse applicant is certainly as almost has a better platform and reaching out. I feel like social media certainly has opened up those doors.
 And I think just how my university is just opening it up and trying to make it easy and accessible. Certainly seems to be much more successful this year. I mean I know that we've had offices with diversity inclusion for years. I know that there's been times where we've actually brought students to campus for a second look, but it definitely was not something that was kind of in the forefront for orthopaedics. And then this year and with this open house having that virtual platform. It gave us a spot at the table, like that we just didn't have before. So, I think if anything it opens it opens up doors and made it easier.
 
Alexander Aleem 22:32
Our concern was that with virtual recruitment virtual interviews, that students especially underrepresented minorities or women applicants in orthopaedics, would have a harder time kind of distinguishing themselves. But our university has very similar kind of university-wide initiatives. They do a special program for underrepresented minorities that's multiple departments. Last year we had a pretty big undertaking in it and pretty good representation from faculty and residents. And actually two of our current interns participated in that. And so that was great because that that was all the proof that we needed and both said that was a big reason why they chose to rank highly. So I think not only department led issues but university led initiatives can go such a long way. 
 And I think with social media becomes a lot easier for students to really sort of let themselves be heard. And so I've actually seen a huge number of applicants, both women and underrepresented minorities, reach out to us through, through Twitter, through just sort of saying, hey, look at me I'm an orthopaedic applicant. Which they may have not had that platform a couple years ago. I think it's a kind of the perfect storm of all the social justice issues going on nationally. I think the AOA has become more aware of it and it's become a critical mission of the AOA over the last year and program, and Program Directors talking about. And the more that we all share ideas and the more that we kind of cross pollinate with these ideas, the better the better it will be. So I think it's a, it's been surprisingly good to see the number of applicants and number of students that are that are kind of showing themselves.
 
Charles Goldfarb 24:08
So, Cassandra, what about taking what you know, and you know you have great students at UC Davis, and you know those students, it wouldn't just be easier just to take a large chunk of your incoming class from your own students?
 
Cassandra Lee 24:24
I think that might be a possibility, but I think we're still very much dedicated to being diverse also from a geographic standpoint. When we talk about diversity and inclusion we're not just talking about underrepresented minorities and female applicants. We're also talking about applicants across the country. I don't want to be that program that I only take people from Northern California. So I think it is the lowest activation energy, if you will, but I think it's still very important to create a class that actually has a lot of diverse input and diverse, kind of, what's the word I'm looking for? Just how they how they look at things. Because if you know students from the East Coast are going to be definitely different than students from Midwest, or West Coast. So, we definitely want that diversity and how you look at things. 
 
Charles Goldfarb 25:18
Yeah, and the med school experiences, and the early you know training experiences, all that matters. And I was obviously it was a little tongue in cheek. But it would be easy just to take the students that you know. But I don't think in the end, that would make the best class. I think we all recognize that Alexander, anything to add?
 
Alexander Aleem 25:34
I completely agree and I think, you know, Cassandra, you made the point and I think it's well taken that we want to stay true to our culture. We want to stay true to what we think makes each of our residency programs the special places that they are. And part of that is not having all of our students come from our home program. And so we want to maintain that and i think that's, I think, all programs feel that way. And I think we've all kind of come to that it's like, “Alright, you know, we know it's going to be more challenging, but we want to maintain why we think our programs are so great.” Because there's a lot of great programs out there, I think it's, it's awesome to see just how we've kind of collectively come together, especially through CORD the last few months to really kind of kind of galvanized CORD. It really has.  To see what's coming out the ideas the cross talk that we've had. It's been really cool.
 
Charles Goldfarb 26:24
It's been interesting to see how COVID has changed so many things in our society. And collaborations now exist that didn't exist before whether that's locally or nationally. I agree like conversations like this are so welcome. And we've covered an incredible amount of ground. Cassandra, we are grateful that you took the time to join us and share your knowledge and experience because I really think it'll be helpful for others. So, thank you very much.
 
Cassandra Lee 26:47
Thanks for having me. I really enjoyed this discussion. 
 
Charles Goldfarb 26:51
Yeah, and I think that for all of you listeners who are CORD members, or, or at an institution that's a CORD member, you really should check out the town hall, which goes over this in detail and the recording has slides that are informational as well. So another resource for those of you who want a little different slant on many of the topics that we discussed tonight. Alexander any closing comments.
 
Alexander Aleem 27:15
Again, Cassandra, thank you so much. I think this is an amazing discussion and I will reiterate the webinar and the town hall that you moderated was absolutely fantastic. And just had so much great information. And it's great to establish these collaborations. And, and keep making orthopaedics the greatest specialty out there.
 
Charles Goldfarb 27:36
Outstanding. You guys have a good night. Okay.
 
Cassandra Lee 27:39
Thank you. You too.
 
Alexander Aleem 27:40
Thank you.