surgery residency

Surgery Residency

Application Guidebook

This guide was adapted from the University of Michigan Surgery Application Guidebook

2013 edition

Managing Editor: Chad Becnel

Contributors:

Katie Carsky, Colleen McDermott, Maria Ragas, Dr. Patrick McGrew

2020, Edition 1

Introduction At the end of medical school, it comes down to this - doing

everything in your power to find the best training programs

for you and maximizing your chances of matching at one of

those programs. At the end of the day, this is an imperfect

science and most of us will only have to go through this

process once (thankfully). This book is a compilation of

advice regarding the match process and represents our

best efforts to provide you with a reliable source of

information specific to students interested in matching in

general surgery. We fully acknowledge that there are many

ways to go about this process and we have not attempted

to cover every possible scenario, but rather to provide some

guiding principles and suggested approaches that worked

for us and others. We wish you the best of luck as you

embark on the interview trail and much success when all is

said and done!

This book can be used as a reference for any stage of the

application process, but keep in mind that it is simply a

guide created by students and should not represent the

information you can receive from a mentor or from the office

of student affairs. One theme of this book is that it is

important to get feedback from many different sets of eyes,

especially mentors you trust and respect.

Table of Contents

Introduction

Critical Dates in the Application Process 1 Tulane Surgery Overview and Timeline for T3-T4 2

Pre-Interview Period:

Finding Mentors 3

Away Rotations 6

ERAS Components and Personal Statement Tips 8

Choosing Letter Writers 10

Choosing General Surgery Residency Programs 11

Scheduling Interviews 12

What To Do If You’re Not Getting Interview Offers 15 On the Interview Trail:

Getting to Your Interviews - Planning Logistics 17

Preparing for Interviews 19

Interview Day Strategy 23

Evaluating Programs 25

Thank You Notes 27 Post-Interview Period:

Making your Rank Order List 29

Post-Interview/Pre-Match Communication 31

Applying to Integrated Programs 37

Example Personal Statements 40

Example Interview Questions 45

PRE-INTERVIEW PERIOD

Critical Dates in the Application Cycle July 1: ERAS opens – first day you can access the system and

begin filling out your application September 15: ERAS submission begins and NRMP

Registration Begins – first day you can submit applications.

SUBMIT ON THIS DATE AND DO NOT BE LATE. September 15 – 30: Programs begin inviting applicants for

interviews October 1: Dean’s letter (MSPE) is sent to programs. Majority of

programs begin sending interview invites AFTER they have

received the Dean’s letter. October 24 – 31: Some programs hold their first interviews

during the last week of October November 1: Application deadline for the vast majority of

programs

November 30: NRMP Registration deadline November – January: Vast majority of programs hold their

interviews during these 3 months

Mid-January: NRMP Ranking (R3 system) Opens First Three Weeks of February: Faculty meet to rank applicants 3rd Week of February: Rank list due for applicants and programs. Ensure you are Certified and Submitted! You will receive an email confirming this. 2nd Week of March: Match status (matched/unmatched)

released to applicants. Unmatched applicants participate in

SOAP (scramble) to secure open positions or preliminary

positions. Specific placement (which program) revealed five

days later on Match Day. Mid-June: Intern orientation starts for most programs *Use this timeline as a checklist to ensure you have completed all steps with ERAS and NRMP

Tulane Surgery Residency Application Guide 1

Tulane Department of Surgery T3-T4 Year Overview

Tulane Surgery Residency Application Guide 2

Strongly advise taking CS as early as possible.

Finding Mentors

How to Find Mentors The process of applying, interviewing, and finally choosing a residency program is

one with many nuances and high stakes. Luckily, you are surrounded by mentors

who have gone through the process before you and who have helped generations

of students through it all. Good mentors are a powerful resource that you should

utilize to set you up for success. Ideally you should aim to seek out and maintain relationships with

Main Points: mentors in many different professional

stages (resident, full professor,

• Have multiple mentors at people in different administrative and

different points in their leadership roles, etc.) and who can

career path speak to different aspects of who you

• Understand each mentor’s are and eventually hope to become. As

the mentee, you play a crucial role in

role and background directing and managing the relationship

and use their knowledge with your mentor. In order to best utilize

and advice accordingly each mentor’s strengths, you should

• Consult your mentors have a general idea of what each

mentor has to offer and have some

frequently; they are your understanding of their background

best resource! and biases. Do your homework and be

familiar with where your mentor has

trained, worked, what kind of research they do, with what other non-clinical activities they are involved, etc. Below are

examples of people you can and should reach out to for advice and the kind of

advice that each might be able to offer:

• Surgery Clerkship director(s): Be in communication with them

often and early on in the process. They have lots of experience

and advice to offer and it will be to your advantage to establish

familiarity and a good working relationship. They can offer realistic

advice about where to turn for your next decision, who to seek for

additional mentorship, or where to go to look for research.

Tulane Surgery Residency Application Guidebook 3

• Surgery Residents: Great first-line of advice for the nuts and bolts of the

interview season. You can ask about their experiences with specific

programs’ interview days, how they evaluated the programs they saw,

their decision-making process, how to prepare for interviews, etc. Keep in

mind that they have a limited sample size from which to draw some of

their impressions. • Junior Faculty and APDs of Home Program: Often they will have a very

good sense of the current status of residency programs, recent changes in

training paradigms (work hours and the shift toward early specialization),

and have contacts with faculty and program directors at other programs. • Letter Writers: Ideally your letter writers are faculty who know you well and

have worked closely with you (more on this later). However, they often will

also be more senior faculty and you should be prepared to present a fairly

polished front when meeting with them. Your letter writers will often not be

people to whom you will send emails about minor questions, but from whom

you can elicit opinions re: your list of programs, your rank list, and who may

be willing to make calls or reach out to people at programs that you are

especially interested in when interviews are all done. • Residents at other Programs: Any residents at other programs to whom

you have personal connections or who are Tulane alumni should be

considered as good sources of inside information. Emailing before or after

an interview to solicit advice or honest opinions about things you feel you

might not have gotten an accurate picture of before, during, or after an

interview is reasonable. However, remember that their allegiance may be

at least partially to their program so you should be reserved and respectful

in sharing your opinions of different programs with them. • Alumni: Use the Tulane Match Map! Faculty and fellows who are alumni

of programs where you are interviewing are usually happy to share their

perspectives. Recent medical school grads and residents who are now at

different institutions are also great resources.


• Senior faculty: Senior faculty have a great historical perspective on

programs and can assess a program’s stability over the years. They will

also often be familiar with the program directors, chairperson and other

senior faculty at other institutions. However, it is important to note that

residency programs can change rather quickly, and reputation and rumor

often lags behind the real-time changes that a program might be going

through. Be sure to not get all of your information from senior faculty, as

this could skew your outlook on what is happening now.

• Surgery Chairperson: All students applying in general surgery should

meet with the chairperson at least once and will get a letter of

recommendation. It is important to be prepared at this meeting because it

is your chance to make an impression and to communicate the things that

you think make you a unique and outstanding candidate and that you hope

will be highlighted in the letter. Think about your future goals, your

motivations for pursuing a career in surgery, and be able to verbalize a few

key characteristics that you want all the programs to know about you.

Additionally, the Chairperson may want to know a bit more about your

personality, leadership style, and any hobbies or interests you have so that

they can create an accurate picture of you in their head. Approaching Mentors: Be prepared to provide an updated copy of your CV,

personal statement, and to provide any additional information that you think is

pertinent to the advice you hope to elicit. For each mentor that your

approach, your familiarity with their background will help you to direct

questions that will make them draw upon their experiences and share their

insight on particular topics of interest.


Away Rotations

General Surgery is a specialty where away rotations are not required, but

they may help you to get an interview or even Match at a specific program.

Do an away at a program that you have specific interest in, and be sure to do

this rotation at a time in the year when you KNOW you will perform at your

best. You will be given mixed advice on away rotations because data is

mixed on their efficacy in General Surgery, but definitely do them if you are

particularly interested in a program or area of the country. Additionally, when

you select you away sites, be strategic in the service you choose. It is

helpful to rotate on the PD or APD service to get facetime. You can rotate

at a place that’s a little bit of a ‘reach” which might help your chances, but do

have a legitimate reason for selecting that program.

You are not guaranteed to get an interview from a place where you did an away, but you do have a great chance at interviewing (and a statistically higher probability of matching) at a program where you did an away. TIPS for How to Do Well on Aways: 1) An away should ideally not be your first sub-i rotation. Learn how to write notes, put in orders, write dc summaries, nail presentations, do handoffs and many other good patient care skills that you might have not done as a T3 before you do anything else. A surgery sub I would be ideal, but even IM is a useful place to learn these skills. 2) Be prepared. Even if the hospital, EMR, staff, or program is familiar, be prepared. Get to town a few days in advance and find a connection. It may help to find a local med student early to show you around. If not, most places have an orientation where you will go over basics. PAY ATTENTION because they usually take you around the most frequented spots. 3) Take initiative. Know how to put a Foley in, get comfortable with self-scrubbing, be eager and willing to do any case, etc. Make all pretenses of planning to stay for every case. Better to have the resident tell you to go home two mins after you get scrubbed in than to have them wonder why you’re not there! Perform at intern level. 4) Be helpful to everyone. When you get to the OR, introduce yourself and your team to the circulator and write your names down, ask them what size gloves your attending and chief wear and get them for him/her. Help prep the patient. If your attending is a literal foot taller than you get a stool in place on either side of the bed before the case starts. Help nurses, techs, etc.

Tulane Surgery Residency Application Guidebook

6

5) Read before the case about BOTH the case and the patient. Read up on the disease, the relevant anatomy and the major steps of the operation. If the attending left the room, could you and the resident finish the case? Read up on the patients’ history too. Know who operated on them before and what was done. Know what comorbidities they have and what meds they’re taking, and also one social history component. It’s hard at the beginning of the rotation when you didn’t meet the person in clinic the week before, but that gets easier. ALWAYS introduce yourself to the patient in Pre-Op; it is often easy to get stressed about your performance that you forget this is the biggest day of the patient’s life.

6) Be able to present well (and adjust your presentations on the fly). Surgeons like brevity, but a lot of academic surgeons like being academics just as much. Also, if your chief asks you to present on a teaching topic, be prepared to present it always (keep notes in your white coat). They might ask for it three weeks later and they’ll expect you to know it still. You should be eloquent and well-read. 7) You will be judged more for how you react to making a mistake than the act of making one. They don’t expect you to be perfect, they just expect you to be a good person who’s doing their best. Don’t EVER lie about something- it’s far better to explain that you didn’t know. Be humble. 8) Meet with the PD at the beginning and end of the rotation. Bring a suit to your Away. Depending on the time of year, it may be important to send your cv, step scores and transcript ahead to the PD so they can have a realistic meeting with you. You can highlight things you're proud of to them and also have a chance to explain anything that might give them pause. It’s important to ask what they value in their program and what they’re looking for when they select applicants to interview. Some sites will interview you at the end of your rotation. Come prepared as if this is an official interview, and wear your suit. 9) If it is an early enough rotation, ask for a LOR. If you do your away before ERAS submission (or if you want a 4th letter) and you feel like you did well, ask one of the attendings you worked with for a LOR. This can be in person or via email, but you want to ask for a strong letter of recommendation. See LOR section for how to approach.


ERAS Components What’s in ERAS?

• 3-4 letters of recommendation (includes Chairperson’s letter but not the Dean’s or MSPE letter)

• CV - activities/awards/publications/etc. - will be entered into an online

format

• Personal statement • List of programs to which you are applying

With each of the ERAS components (personal statement, CV, letters), it

really, really helps to start early. Having your draft CV and Personal

Statement (even if in a rough, but presentable draft form) ready for your

Dean’s letter writer and other letter writers will help make each item more

compelling. Personal Statement For most people, this is the most difficult part of your application. In general,

you want to fly under the radar by writing something compelling but relatively

“in bounds”. Generally, 10% of personal statements are very good, 80% are

solid, and another 10% are deal-breakers. The goal is to have a personal

statement that is solid. Many of your interviewers may merely skim it for red

flags or interesting things to talk to you about (remember: anything you put in

your CV/PS is fair game for your interviewer to bring up).

Some Personal Statement Tips:

• Cater to the skimmers and write something simple (ONE PAGE).

• A good “hook” works very well. This is usually an opening statement

(or one within the first few sentences) to grab your reader’s attention.

• To write your personal statement, the single best thing you can do is

just sit down and write something – and do it early. Doing so will allow

you to get feedback from your letter writers, who probably are or have

been interviewers themselves and know what makes for a solid

personal statement.

• Put the Personal in Personal Statement. Most PD’s are looking for

someone they want to meet in person. Talk about something

interesting about you that makes a program director wish they could

talk to you face to face and learn more about your life.

• Do not use patient anecdotes. It’s a trope that’s overdone and most

PD’s don’t like it.


• Don’t explain what surgery is. Actually avoid lines that say “Surgery

is…”

• Programs are looking for qualities that will make you an asset to the

residency. Explain how your life story has given you these qualities

and substantiate them. For example, if you’re an athlete you can

demonstrate that you know how to pick yourself back up after a

setback or loss. If you have an MPH, you’ve been taught to value

people who are different from yourself, etc. Do some research (ask

your mentors!) about what qualities they would want in an ideal

resident, identify those that you feel in yourself, think of where you

learned those and convey that in your PS.

• You can convey your specific interest in a region in your PS and write

several different versions to send to specific programs. Programs

actually read the PS, so this may be your chance to get a bit specific.

• (Example personal statements at the end of this guide) Letters Give each of your letter writers as much notice as you can to get their letters in

for you, but also give a hard deadline that is several weeks before you want to

submit your ERAS. Everyone is busy. Remember to always be extremely

cordial with your reminders. Your letter writers should be SURGEONS who

have worked with you clinically and ask each if he or she would be able write

you an “excellent” or “very strong” letter. When you email each letter writer, it is

often best to set up a physical meeting to discuss writing your letter and to

provide a copy of your CV and PS. Again, giving each writer your CV and PS

forces you to get several rounds of feedback on each item. Additionally, they

have more information to highlight in their letter. (See “Choosing Letter Writers”

on next page)

CV Everything on your CV is fair game for questions on interviews. With that

said, there are two forms of your CV that you need. First, a CV that you can

give to letter writers to facilitate their writing awesome letters. Second, your CV

in ERAS form. For the latter, just like on the medical school application, you

have a couple lines (~1000 characters) to explain each activity. There is a

“print CV” option in ERAS that will help after you’ve input your activities and

experiences. Like your personal statement, start ASAP and sit down and write

a CV, then revise, revise, revise after having your advisors look it over.


Choosing Letter Writers

Surgery Faculty from Third Year Ideally, you have stayed in touch with one or two

surgery faculty whom you met during your 3rd year

rotations. Clerkship facilitators are often a good source, because you have met with them outside of regular clinical duties and medical student education is important to them. Try to meet as early as possible with these surgeons so that your third year is fresh in their minds.

Other Faculty from Third Year

It is not recommended to include letters from faculty

in other disciplines besides surgery. The only

exception would be if you have done extensive

research with that physician. Many residency

programs value surgeon letters significantly higher

than non-surgeons. Plus, a surgeon knows the

attributes someone needs to excel in the field and

can best highlight those in a letter.

Research Mentors Important if you are interested in academic residency programs. Instead of just focusing on your clinical acumen, these letters emphasize a different skill set that will be important in the future. Moreover, you will probably have spent more time with these faculty, so they truly know you better and can write more anecdotally.

Surgery Faculty from 4thYear

The majority of letters will often be from this group. Sub-Is in May, June, and July are ideal. It is best to request a letter right after working with someone, so they can best remember your performance. You

have learned a lot during your 3rd year and can

really shine during these rotations, giving faculty a lot of good things to write about.

Chair Letter

The Chair of Surgery will write a letter for all

students applying in general surgery. STUDENTS

SHOULD set up a meeting or risk not getting a

letter. Be prepared for this meeting as it may be

your first and only chance to make an

impression and communicate things you’d like

highlighted in that letter.

ERAS Requirements A. You can store as many letters as you want in

ERAS, but you cannot send more than 4 to any one program.

B. “Finalize” each potential letter writer in ERAS and print a cover sheet before asking for a letter. “Finalizing” just creates a slot for the LOR to be uploaded and does not mean you have to send out that letter to programs.

C . ERAS allows you to send different letters to different programs, which is ideal if you’re applying to both General Surgery and integrated programs.

D. Although it is possible for letters to be uploaded after submission of your ERAS application, try to avoid this. Ask early!

How to Pick Specific Faculty

1. Pick faculty whom you have spent the most time with and who know you best.

2. Letters from full professors as opposed to associate or assistant professors may carry slightly more weight. Letters from faculty who are well known nationally in their field may also carry more weight.

3. Pick faculty who can highlight your different strengths: research vs. technical skills vs. patient management, etc.

4. Ask for letters with the phrase: “Can you write a

strong letter of recommendation for me?” 5. Try to ask for letters in person with a copy

of your CV, personal statement, and list of programs. You can also solicit advice about programs and your personal statement at the that time

6. Send faculty thank-you notes after they submit your letters to ERAS

7. Faculty write letters every year, so they know to expect requests. Try to give as much lead time as possible and follow up with polite reminder emails as necessary


Choosing General Surgery Residency Programs

Academic, Community, or Hybrid Programs Large academic centers are usually best suited for those with a robust interest in research and/or other academic interests outside of a clinical career in surgery. Many academic programs require 1-2 years of research time during residency while other programs offer optional time for academic development; these programs vary from 5-7 years in length. Some will have “research optional” but be sure to get clarity on what that means because it is different from program to program. Community programs are usually more clinically focused, may have higher case volumes, and are usually 5 years of clinical training. Hybrids are just that: community-feel programs with a bit more opportunity for research. These may have a small medical school attached to the hospital or may have more academic faculty.

Geographic Restrictions Do you want to live in a big city, near family, or only on the East/West Coast? Where is the nearest airport and how expensive are tickets? You have to live there for 5-7 years, so truly try to imagine your everyday life there. Many of the top programs have similar clinical and research opportunities, so location really separates them. Though geography matters, your support system matters, too!

Faculty/Mentor Suggestions Faculty can offer good insight into programs’ reputations. Junior faculty mentors are an ideal starting

point as they are far enough along in their careers to understand some of the pros and cons of

different training paradigms and close enough to the residency process to know about more recent

changes in program characteristics and reputations. Senior faculty have a great deal of experience to

draw from, but their knowledge of programs may be dated, depending on how closely they follow

current events. Usually the Chair, PD, APDs, and other faculty with medical education backgrounds

are some of the best sources of information because they are aware of new developments and

resident education at institutions. The key is to solicit suggestions from multiple sources and to find consensus.

Resident Suggestions

Residents are great sources of information because they have interviewed recently at many of the programs to which you will apply and may have friends at other institutions. If you hear a program recommended over and over again, it’s probably worth applying to.

Specific Program Characteristics to Consider 1. Research faculty/projects or multidisciplinary research centers that correlate

with your interests/expertise. 2. Quality of fellowship programs that residents match into. 3. Prominence of particular department of interest. 4. Reputation for collegiality vs. hierarchical environment.

Main Points: 1. Talk to many people to solicit advice and suggestions. 2. Include both “dream” and “back-up” programs. 3. Take all advising with a grain of salt. This is YOUR match.

How many programs should I apply to? There is no great way to predict how many programs you should apply to. Application creep

has occurred over the past few years, with the 2020 average being around 67 applications per

applicant. The graph for number of applications is increasing exponentially. Projected average

applications for the next 5 years are: Year 2021 2022 2023 2024 2025

Projected Applications 70.9 76.2 81.9 88.1 94.8

*source: ERAS applicant data. Projection based on 2011-2020 historical data. Equation y = 31.847e0.0727x


Scheduling Interviews

GENERAL RULES:

1. Be near your phone/computer at all times from September 15 – Early November. Programs often send more invites than they have spots for, so you need to be fast in responding to invites. When scheduling or rescheduling interviews, spots fill up very quickly, so prompt communication will maximize your chances of getting the dates you want.

2. Be courteous – A program’s surgery education office is responsible for

scheduling and rescheduling interviews. They are the gatekeepers. If you

come off as even slightly rude, you may be blackballed before you spend a

dime on traveling there. Be courteous, even if the person you’re talking to

isn’t.

As Interview Invitations are Sent:

• If you want, you can use the Reddit General Surgery spreadsheet to get

a ballpark of what programs are offering interviews. TAKE REDDIT WITH

A HUGE GRAIN OF SALT because people often mislead and lie (hiding

behind anonymity).

• Once you get an invitation, you can quickly browse through the

potential dates of other programs to minimize clashing and to try to

schedule programs in the same city together

• Invitations are sent by email, and spots fill up very quickly. Check your

email frequently, or you may miss out. Smart phones with “push”

notifications for email are very helpful. “Push” means your phone goes

off whenever you get a new email (you don’t have to manually check it.

• Set up email forward to text on your phone so that any message with the

word "interview" or from "[email protected]" shows up as a text. Also

set this up to go to your mom or significant other’s phone and train them

how to log into your Gmail, ERAS, and calendar. Keep all interviews and

dinners in one calendar.

• Many people will have a family member or significant other check their email or download to their phones just in case you are scrubbed in or on an away rotation.


Accepting Invitations:

• Respond ASAP – spots fill up very quickly • Respond in the way they tell you: email, form response, or specific

websites. • Read the invitation carefully before responding. It often asks for

specific information in your reply

Example: Accepting Invitation by Email

Hello ___________,

Thank you very much for the invitation. I was hoping to

interview on December 4-5 if that session is still available.

Please let me know if you need any further information from me.

Thanks again for the invitation. I very much look forward

to interviewing at [program name]. Best,

____________

How many interviews should I go on? Based on NRMP data, 12 or 13 interviews is the “magic” number to match into general surgery. With this being said, many people will advise you to go on as many interviews as you are able to. This is a multifactorial decision, but if you receive more than 13 offers, you should go on interviews at programs where you are confident that you would attend residency. Use the “Interactive Charting Outcomes” tool on the NRMP website to help with this and more regarding competitiveness.


Cancelling/Rescheduling/Declining Interviews:

• Don’t worry – programs expect some applicants will cancel/reschedule, so

they are usually forgiving if this is done with appropriate lead time.

• Being courteous and professional is of particular importance. Lack of

gratitude when cancelling interviews will burn bridges.

• Whenever possible, notify the program AT LEAST 2 WEEKS in advance

so they can reschedule you or offer your spot to another applicant

• If you cancel/reschedule on short notice (< 2 weeks), you need to have

a convincing reason (death in family, severe illness)

• If you cancel/reschedule ahead of time (> 2 weeks), you do not need to

give a specific reason

Example: Cancelling Interview by Email > 2 weeks ahead of time Hi _____________,

My name is ________ and I am currently scheduled to interview at [program name] on January 12th. Unfortunately, I will have

to cancel my visit. I am very sorry that I will not be able to

make it. Please convey my sincerest apologies to Dr. [program

director]. Thank you again for the invitation. I sincerely regret

having to cancel my visit. Best,

________________

Example: Rescheduling Interview by Email > 2 weeks ahead of time Hi _____________,

Thank you very much for the confirmation. I was wondering if

it would be possible to reschedule my interview for December

15th. December 8th would also work for me. I understand that a limited number of candidates are

interviewed on each date, and would be happy to keep my

previously scheduled date (Jan 5th) if this is not possible. Thanks so much. I very much look forward to interviewing at

[program name]. Best,

________________


What to Do If You’re Not Getting Interview Offers

Key Points • It’s OK to freak out: After that, take a deep breath, talk to your

faculty mentors, and take action.

• When to Start Worrying: A few days after the Dean’s letter is released on October 1st. If you’ve only received a handful of interview offers in the first 2 weeks of

October, you may need to submit additional applications to less

competitive programs.

• Critical Timing: Application deadlines for most programs are October 15 or November 1st. If you’re starting to worry and want to apply to

more programs, you need to do it before this. GET FACULTY

INPUT.

• Remember: Programs offer interviews in several cycles, and applicants

can match to outstanding programs even when they are among the last

to be offered an interview. If you get a late interview, it does not diminish

your chances of matching at that program.

The Setup

You’ve submitted ERAS and all your letters are in. You’re waiting for

interview offers to arrive and nothing. Alternatively, you’ve received some

invitations, but haven’t heard back from more competitive programs.

Additionally, you may know other applicants have already received

invitations from these programs.

Timing

Programs can begin downloading ERAS applications on September 15.

Most will wait until after the Dean’s letter is released on October 1 before

sending out invitations for interview. A few programs do issue interviews in

late September, but the majority of programs, especially the larger

academic institutions, send interview invites after the Dean’s letter is

released throughout the month of October.

Another important date to keep in mind is October 15 and November 1.

These are the most common application deadlines for the majority of

programs.

If you haven’t received many offers in the first two weeks of October, it is

important to evaluate the need to take some extra steps. This includes

working with programs you have already applied to or applying to

additional programs.


What You Should Do

1. Talk to your mentors. Bring a copy of your CV (board scores, clinical

grades, research) and your current list of programs. If there are particular

programs you are interested in, ask if they have connections at those

programs or could connect you with faculty who do. Some faculty will

directly offer to make phone calls on your behalf for interviews. Ask them

if you need to apply to a few less competitive programs.

2. For programs you have already applied to or those that you may have

added already: Emailing the coordinator or PD is usually the best option.

Be sure to include specifics about the program and why you are

interested in interviewing there. Make it personal and briefly describe

how the program pertains to your own strengths/future interests.

Mentioning family ties, city interests, and specific personal reasons for

wanting to be there. Sincerity goes a long way here.

3. For programs you are considering applying to: Call ahead to see if they

are still offering interviews. Once you have submitted your application,

email the residency coordinator to inform him/her that you’ve just

submitted your application and follow step 2 above to mention your

specific interest in the program.


Compiled interview offers from the 2020 Reddit General Surgery Spreadsheet. This graph shows the majority of interview offers were extended by early October.

ON THE INTERVIEW TRAIL

Getting to Your Interviews - Planning Logistics

Once you’ve scheduled your interviews there is a good amount of planning

that is needed to help make the interview trail run smoothly, minimize

stress and help you get where you need to be on time. The major logistic details that should be addressed before each interview:

1. Getting to the city where the interview is being held a. Check the schedule for the interview day(s) and social event

when purchasing your tickets. Most programs will have a social

event (dinner or reception) the evening before the interviews and

then a day of interviews following, but there are many variations

on this theme. It is always a good idea to ask when the interview

day officially ends, before booking travel.

2. Getting from the airport to your next stop, which is usually your hotel

or the social event.

a. There will be times when you will arrive without enough time to

stop by your hotel to drop off bags and change. Plan ahead and

have your outfit easily available so you can change at the

airport if you need to head straight to the venue. b. Map out how long it takes to get from the airport to your lodging

so you know your time constraints. If you rent a car, you can

inquire ahead of time about the parking situation both for the

social event and on interview day.

3. Getting from the social event to your lodging. You should have a plan

for how to get home after the event so you’re not stranded or stuck

staying later than you want at the event when you have an early day

ahead on interview day. Plan for the worst, including weather. Pack an

umbrella, snow shovel, whatever you *may* need.

4. Interview Day: Getting from lodging to interview site. You will usually

get information about meeting time and location for interview day at the

social event the night before, if not in advance via email. Make sure you

know how to get to the meeting place and know how long it will take

you to get there. If taking an Uber, test out the location and map

beforehand to gauge timing and distance. Some places will offer a

shuttle. If walking, allot extra time if walking in heels. Aim to show up

10-15 minutes early.


5. Interview site to next stop, either back to lodging or to the airport. Again,

plan ahead to determine if you have enough time to go back to your

hotel, pick up your bags and head to the airport. If not, you should bring your bags with you to the interview day and make sure in advance

that there is a place to leave your belongings, and that the interview day

coordinator is expecting you to come with bags. You should leave

yourself extra time on interview day morning for this.

6. Finally, interview’s done and it’s off to the airport and then home or to

another interview. There may be times along the interview trail when

you will have back-to-back interviews and will be on the road for days to

weeks at a time without a stop back home. Plan and pack accordingly.

Remember to take into account changing time zones when planning

travel. If you check your bag, always carry-on your suit in case your

bag gets lost. Timing: It can be difficult to plan all these details because interview invitations

will roll in over a few weeks and you may find yourself with schedule conflicts.

Before you find yourself in this situation, you should have a rough idea of

which programs you would prioritize before others, so you feel comfortable

cancelling/rescheduling according to the interviews you want most. Some

programs will announce their interview dates and you can create a calendar of

possible interviews to see where potential scheduling conflicts will arise.

Because most interviews do not take place during peak travel season, it will

usually not be difficult to find the flights needed, even when booked only 2-3

weeks in advance. TIPS:

• GET A TRAVEL CREDIT CARD. The points will benefit you at a later time whether during interview season or in T4 post-interview season.

• Southwest Airlines: no fee for changing itineraries, free checked baggage

• Most programs will have discounted or free lodging, so wait until

you are given this information before you book.

• Find a consistent way to keep all your interviews and travel schedule organized, and make sure to update it as you switch/cancel interview dates. Most people use Excel or Google sheets.


Preparing for Interviews The Highlights:

• However you practice, make sure you practice and have answers

to commonly asked questions.

• Go through your CV and make sure you can succinctly discuss

each aspect of it.

• Approach the answer to every question as an opportunity to highlight

a unique aspect of yourself and of your application - be thoughtful,

demonstrate insight. DO NOT BE NEGATIVE.

• Get feedback from faculty The Full Story: Congratulations, you have received your interview invitations, set the dates,

bought the plane tickets, and set up the lodging. It is now time to prepare for

your interviews. Fortunately, to have gotten to this point you have already

bypassed the first cut-off. Over 1000 students apply to each program and most

programs will interview less than 100. You have already made it to the

program’s short list. With that being said, the interview is the most important

aspect of your application and can make the difference between matching at

your first choice and falling lower down your list. Being properly prepared for

your interview will allow you an opportunity to display your accomplishments

and your personality. Practicing for your Interviews The first step to prepare for your interviews is practicing. Students prefer

different methods to simulate interview situations. Mock interviews provide a

secure environment to practice interview techniques, body posture, eye

contact, as well as common interview questions. You can seek out mock

interview sessions with the school counselors/career advisors or practice with

a friend. Practicing with friends offers a relaxed environment to rehearse

different answers to common questions but lacks the professional opinion on

substance and style that other methods provide. Likely, the best option for a

mock interview is a faculty mentor in surgery. Schedule these mock interviews

early and be prepared to take constructive feedback to improve your interview

skills.

*Tulane also typically interviews home students very early so that you can get

a feel for the process and receive feedback on your interview abilities.


Along with mock interviews, being prepared for common questions can help

ease some of the tension involved with surgical interviews. Some students find

that outlining the answers to specific questions is beneficial. While the outline

provides the student a chance to think about a question, it also maintains an

answer’s sincerity in real interviews. The golden rule: BE YOURSELF. Some Common questions are included at the end of this guide. A great starting point for situational questions is the STAR method: Situation, Task, Action, Result. This gives a great framework for how to properly setup and deliver a proper response. It is also important to think of answers to questions specific to your application. For instance, if there is a specific deficiency in your application, you should be ready to answer questions regarding that deficiency in a positive way. Also be ready to describe any and all aspects of your application. If you included a research project from prior to medical school, you should be able to describe the project in detail in your interview. Some interviews have ethical questions so it is important to develop your own method to answer these types of questions. Think of ethical scenarios you witnessed during med school and be prepared to discuss the reason you or your team acted in that manner. Going into your interviews you should also know the assets of the programs at which you are visiting. Most general surgery programs have good websites which can provide you with the program’s mission statement, the basic structure of the program, recent accomplishments of the faculty, research opportunities, and recent graduate placement. Mentors can also help you by pointing out a program’s strengths and weaknesses. Having this information can aid you in developing well thought-out questions for your interviews. Gathering this information will also help later down the road when making your rank list. On the topic of questions you should ask in interviews, there are generally two categories: questions you are asking in order to get information and questions you are asking in order to steer the interview. This may sound superficial, but the truth of the matter is that you may get half of the allotted interview time to ask questions, and this is your opportunity to lead the interview. You should absolutely ask any questions to clarify information on the program, residents, etc. Beyond these informational questions, you can also ask questions that may steer the conversation toward an area of discussion that you would like to talk about (or that your interviewer would like to talk about). This is a bit of psychology here, but you want your interviewer to shake your hand at the end of your time thinking you are the best person they’ve talked to in a while. Take a look around their office, read their questioning style, know their specialty/research, and ask questions accordingly. This is not to say that you should answer questions the way you think they want to hear it. The opposite is true: answer all questions truthfully and be yourself. But in other discussions and questioning, you can be the person to do everything in your power to leave a positive impression on your interviewer.


Looking the Part It is important to keep your clothing professional and conservative. This is not

the time to try out new fashion trends or hairstyles. Men should wear a black,

navy, or grey suit. The shirt should be a solid color and should be matched to

an appropriate tie. Shoes should be black or brown. Hair should be maintained,

and facial hair should be well trimmed. Women should wear dark pant or skirt

suits. Non-collared shirts are perfectly acceptable to wear under your suit

jacket. Again, no low cut shirts or short skirts. In general, hair longer than

shoulder length should be tied. Remember, these interview days are long and

there usually is a tour of the facilities involved, so shoes should be comfortable.

Proper attire at the night-before resident meet-and-greet events is also

important, and ranges from casual to business casual. You can email the

residency coordinator prior to your interview to find out the dress code. For

men, it is usually appropriate to wear black or khaki pants with a button-down

dress shirt and for women a blouse/cardigan with a skirt or slacks is pretty

standard. Pre-Interview Dinner

Not only do the meet -and-greet events provide a great opportunity for the

residents of the program to get to know you, it also provides the interviewee an

important opportunity to discover the personality of a program. While these

events are normally not absolutely essential, it is always recommended that

you attend. These events are usually only for residents and interviewees,

however, as mentioned above, faculty may attend at some programs. Ask

questions! Where are you in your training, what specialty are you interested in,

where do you live, what’s the culture of the program like, any advice for

interviews tomorrow (this one can be surprisingly valuable).These events are

usually billed as a relaxed environment to get to know the program’s residents,

but it is important to remember that most programs will seek feedback from

residents following the event. With this in mind remember to remain

professional. Alcoholic beverages are supplied at most of these events, and

while the residents may drink more heavily, keep yourself to a maximum of 1-2

drinks. Every year there are embarrassing stories of applicants drinking too

much at these events, and these stories can easily spread to other programs.


Finally, here are some tips to remember when going into your interview: It is

important to be on time. This can be difficult as you may not know your way

around this new city. If you have time, try to find the hospital the day prior to

the interview. Make sure to leave with plenty of time in the morning and to

ask your hotel the easiest way to the hospital. At your interview, remember to

be nice to everyone you meet. Shake hands, say please and thank you, and

smile. You never know who is watching and who will offer an opinion

regarding your application.

Once again, congratulations on obtaining your interviews. Preparing for

interviews will help you stand out as a lead contender for the residency

positions. Utilize mock interviews, rehearse your answers to common

questions, and do your homework with regards to the programs at which you

are interviewing. Dress professionally and conservatively. Enjoy your time at

the night-before event, be on time, and, finally, remain cordial and friendly

throughout your interview. Although this can be stressful, remember that this

is an exciting time where you get to meet surgical leaders throughout the

country and visit new cities across America. Have fun!


Interview Day Strategies What to bring to every interview:

• Copies of your ERAS application and CV. (If you are an artist, you may bring a few copies of your work. Not a full portfolio, but maybe 3 examples of best/diverse work.)

o Interviewers will ask you specifics about your research experiences,

personal statement, or prior activities – it is always good to refresh

your memory! • Consider drafting responses to questions you are totally expecting and

bring this with you • Can just be bullet points, helpful to review while waiting for flights

Things to prepare for each program:

• List of people you may meet: o Faculty members with your research interests, specialty choice

o Chairs, Program Directors, etc. – Make a list of names and

specialties • List of the reasons you were interested in the program in the first place

o You will frequently be asked why you wanted to apply or join the program

• Include specific research interests, strong clinical experiences,

global health, etc. o If you went to the night before, comment on what impressed you

about their residents

• List of questions to ask the program – For both residents and

faculty interviewers

o You will be asked “do you have any questions for me?” more times

than you can imagine.

You may only get 10-15 minutes with your interviewer, so frame some of

your questions to get the most out of your time.

On Interview Day:

• Always be “on.” Treat everyone you meet with utmost respect and

kindness. Your behavior must be polished from start to finish.

• There will be down time. This is not let “your hair down” time. Stay polite,

courteous, and genuinely professional.

• Do not talk badly about other programs, including your home program.

If you didn’t like it somewhere, this is not the time to air your grievances.

Be professional and positive.

• You will definitely talk to other applicants throughout the day. These people

will be your peers for your entire career, so treat them as such. Make

friends, exchange info, and have fun!


Interviews:

• Pace yourself, interviews are anxiety-provoking so take a breath to

organize your thoughts before answering questions.

• Be confident in your responses, always answer questions honestly,

positively, and succinctly.

• Be able to tell your story in 1, 3, 5, and 7 minutes (i.e. have different

versions of your “pitch” to fill the time appropriately). A good way

to practice this is be able to answer the “tell me about yourself”

question concisely but also be able to get through the interview if the

interviewer says nothing else.

• Don’t be afraid to ask about things you are concerned about –

research, specific lab experiences, strength of individual departments.

Do not be offensive when asking “concern” questions.

• Stress questions or harsh interviews will happen. It is on you to

always be positive and show how you react to stress (sometimes

these stressful interviews are on purpose to see your reaction).

• Clinical scenarios, technical skills, and “what would you do if…”

questions do happen in general surgery interviews. Answer honestly

and perform to your best ability. Be coachable, teachable, and

confident yet humble. • Illegal questions will happen, but an interview is a bad time to take a

stand or make a point!

• Give them whatever info you are comfortable with, but do not get

upset during the interview.

• Fill remaining time with questions, and try to make it conversational.

If you are given 15 minutes for an interview, they may finish asking you

questions at minute 5. You don’t want to end your interview in 5 minutes,

so it is on you to lead the interview for the next 10 minutes to paint the

best picture of yourself. See pg. 20 for additional strategy. After Each Interview:

• Write notes about what you discussed with each interviewer, it is really

easy to fall out of this habit but it makes thank you notes so much

easier/ faster. You can update a spreadsheet or Google Sheet to keep

track if you want as well. This strategy is discussed later in the guide. • You can easily plug a specific sentence about what you discussed,

then they know you remembered the conversation

• Before leaving, ask the residency coordinator for emails/addresses if

you plan to send thank you notes.


Evaluating Programs Short version:

• Pick criteria, apply them to all programs, expect them to evolve with time • Keep a journal or spreadsheet and write down your impressions

right after each interview

• Use both a qualitative (gut feeling) and a quantitative system

(point system) of evaluating programs There is no consensus on rankings of the “best surgical programs” because

everyone’s criteria differ. In truth there are a large number of excellent

programs that will train you well as a surgeon. In evaluating programs you

should take into account all of the factors below, knowing that not all are

equally important to you in making your final decision. Take into account things

outside of just your clinical training - i.e. family, academic interests, health

policy, etc. Remember that although the interview is a time for you to sell

yourself to programs, it is also the time when you should be critically

evaluating the programs to make sure they are right for you.

Create a spreadsheet which includes all your interview programs and

columns for all your priorities. You can update this as you interview, and

it may help to have a numerical ranking system for your programs but

also some qualitative data for you to reference when you are ranking

programs in the Spring.


FACTOR THINGS TO CONSIDER

Location Close to family, friends? Cost of living? Will you enjoy living in this place for 5-7 years?

Social event Was there good resident turn out? Did the residents seem to genuinely like each other

and get along well?

Residents Were the residents fun, interesting, people you could see yourself working with? Are the

residents happy? Can they name specific things about the program that they like?

Physician extenders Is there good support from PAs, NPs, etc. to help you with floor work so you can get to

the OR even as an intern and PGY-2?

Program Director, Is the Program Director approachable, do the residents consider him/her to be a good

Chairman advocate for residents? Is the Chairman someone who prioritizes resident education and

training and who will keep the program on solid footing?

Didactic curricula What is the curriculum for ABSITE and general didactics? Is there a structured

curriculum for lap skills, surgical knowledge, or is it a do-it-yourself program?

Academic/Professional Many academic centers will have the option or the requirement for residents to engage in

Development Time some sort of academic development period. Most often this will be for a 2 year period

after the PGY2 or 3 year. What are the resources available (salary/grant support), what

types of experiences are approved (additional degree programs, research, international

experiences, etc.) does the program have mentors that you would want to work with?

Sites What other sites will you cover as a resident in addition to the main hospital? Is there a

VA or a city/county/community/private practice hospital experience? Often times you will

have much greater autonomy and higher case loads at training centers like a VA or

county hospital

Strength of specific depts., If you have a specific interest in a sub-specialty or academic topic, inquire as to the

researchers resources and strength of those departments

Stability of program Have there been recent changes in leadership or impending changes that would disrupt

your training? Recent ACGME violations, probation status?

Culture What is the overall culture of the program? Soft and cuddly, malignant, work hard, play

hard, etc. Beware that many programs will have reputations that prove to be false. Make

your own determination after you see the program

Work hours compliance What measures have been put into place to achieve compliance - hiring of physician

extenders, night float, etc.? Are residents routinely working more than 80 hours and

pressured to underreport?

Benefits, vacation Not the most important things to base your decision on, but important to note and may say

schedule, salary something about the program’s philosophy

Fit An overall impression of whether or not the program’s structure, resources, people and

culture create an environment in which you think you can thrive


Thank You Notes When: ASAP –next day if possible, but within a week is fine. You want their

impression of you to be fresh when they read the note. Who:

For All Programs: Program director + all people who interviewed you (if

the chair interviews any applicants, then he/she should get a thank you

note under the assumption that he/she is fairly involved in the rank

process). NO GROUP THANK YOUS. Individual notes only.

If Particularly Impressed: Chair and interview coordinator How:

1. Be sincere, succinct, honest 2. Include specifics about your conversation with the person 3. Avoid being formulaic. Thank you notes are included in your file and can

be read by all faculty

4. Avoid specifics on where you’ll rank them (even late in the interview season)

5. Double-check everything (names, spelling/grammar). Errors will

reflect very poorly on you.

Why: Most programs expect to get one – not sending one demonstrates

clear lack of interest. Point: Even the most eloquent thank you note is unlikely to elevate

their opinion of you Counterpoint: A poorly-written, late, or non-existent thank you note CAN worsen their opinion of you (ex: well-qualified candidate comes off

as arrogant) Bottom Line: Write your notes carefully and promptly, but don’t slave

away over them Handwritten vs. Email: Frequently debated point, but largely a matter of

personal preference. Doesn’t matter much in the end as long you as send

a well-written note promptly.

PROS CONS

Demonstrates thought and attention- Time-consuming to write and deliver

Handwritten

to-detail

There is a certain romanticism about a Faculty rarely respond

handwritten note.

Must write neatly

Faculty who were impressed will often

Email

reply and say this to you

Faster to write, instant delivery May be frowned upon by “old-

school” faculty.

Good if you have bad handwriting


Example: Thank You Note to Faculty/Resident Interviewer Dear Dr. _________,

Thank you very much for taking the time to meet with me during

my visit. I very much enjoyed hearing your perspective on how

the training for vascular surgery continues to evolve. Throughout my visit, I was greatly impressed by the program’s

commitment to excellence in patient care and clinical

training. I was also particularly impressed by the residents

and faculty. Their camaraderie and dedication to fostering an

outstanding training experience truly set this program apart

from others. They are exactly the kind of people I hope to

work with during residency. Thank you again for your time and consideration. I was greatly

impressed by the program and hope to receive strong

consideration for a residency position. Sincerely,

_____________

Example: Thank You Note to Program Director Dear Dr. __________,

I wanted to thank you again for inviting me to interview at

[pro-gram name]. I very much appreciated having the opportunity

to spend time with the residents currently rotating on the

vascular service. During my visit, I was greatly impressed by the faculty and

residents. Their collegiality and dedication to fostering an

out-standing training experience truly set [program name] apart

from other programs. They are exactly the kind of people I hope

to work with during residency, and I would consider myself very

fortunate to have the opportunity to train at such an

outstanding program. Thank you again for your time and consideration. I was greatly

impressed by [program name], and hope to receive strong

consideration for a residency position. Sincerely,

_____________


POST-INTERVIEW PERIOD

Making Your Rank Order List Everyone is going to have different criteria and reasons rank one place over

another, but beyond that single program or location that you may be banking

on, it can be challenging to feel completely confident about your ROL. Below is

the method some use to figure this all out. It is just one way, but it works. Before interviews: After all interview offers and cancellations have been made,

you will have a final list of programs. Go ahead and make a preliminary rank

list and tuck it away for later. This may be based largely on reputation of the

programs, and this rank list should change. During interviews: After you complete each interview and evaluate the pro-

gram, feel free to tweak your list. Some programs might drop quickly in

your list while others rise to the surface. But treat it like a living document

as you complete interviews and evaluate programs. After interviews: Congrats! Now it is time to really work on your list. At this point

you have probably done a bit of soul searching and have boiled down your

method for evaluating programs into a few critical elements that will guide

ranking. It may be quality of program and reputation, opportunities in the

specialty you are pursuing, and quality of living (based on the lifestyle that

matches your personality), etc. Essentially this comes down to meshing the

list of programs with your list of priorities.

Step 1: Send any program you do NOT want to train at to the bottom

of the list. So ask yourself, “Worst case, would I rather match here for 5-

7 years or SOAP” - this is something that should be discussed with a

mentor, but SOAP is typically NOT ADVISED as an option. The one

caveat is please attempt to rank at least 13 programs on your final ROL.

Stats show that every unit less than 13 further reduces applicant chances

of matching.

Step 2: Break your list into groups. Top group is first tier programs you

would love to go to. The middle group can be first tier programs that you

kind of liked or second tier programs that you really liked. And the bottom

group is second tier programs that you kind of liked or third tier programs

that you really liked. (This “tier” system may be based on rankings,

research, or your own grading method prior to interviews). You will

probably end up with 3 or 4 programs in each group. From here on, the

ranking becomes more “head-to-head” to move programs up and down.

Making progress!


Step 3: Hash out the details. This is usually the hardest part —zooming

in and figuring out your true preferences. For each group, it might help to

make a separate ROL for each criterion you value. For example, make a

list based purely on location. Then one for quality of program. And so on.

You might start to see some patterns or at least be able to solidify a few

spots on your list. Refer back to the criteria in the ‘Evaluating Programs’

chapter for other factors that may be important to consider. Step 4: Allow plenty of time! As soon as you can enter your rank list,

DO IT and CERTIFY IT. Let it sink in for a few days and see how it feels.

Then make adjustments as your frame of mind evolves throughout the

month prior to the deadline. It is also recommended to get early input

from your mentors, letter writers, family, and advocates. Eventually your

list will settle in, and you will become confident in my choices. Step 5: Make sure your ROL is certified. It should say Certified ROL.

You’ll get a confirmation email and that is it. If you make any changes

just hit the certify button again. Try to avoid making changes right

before the deadline. Stats show a high rate of regret among

applicants who do this. So give yourself the necessary time. After that,

good luck!


Post-Interview/Pre-Match Communication The Short Version:

• THIS IS ALL OPTIONAL. You can have zero communication and

match perfectly fine.

• 3-4 weeks before your rank list is

due: o Find faculty who will advocate for you at your #1 choice o Send an email to program directors at your top 3-5 programs

• General rules to follow when communicating with programs:

o Never mislead a program about your rank list o For your #1 program: tell them in no uncertain terms you’re

ranking them #1 o For #2-5 or so: convey sincere interest, but no specifics on

where they’re ranked

• When responding to messages from programs: o Take everything with a grain of salt. o Be prompt, positive, and truthful.

• Caveats:

o Not all programs send out emails, even to applicants they will be ranking highly. Don’t get nervous if you don’t hear anything

from your top-ranked programs o Some programs may send out emails that overstate how

highly you will be ranked; never base a rank decision based

on these communications.

––––––––––––––––––––––––––––––––––––––––––––––––––––––––

THE LONG VERSION

So you’ve made a preliminary rank list and identified your top choices. It is up to you whether you would like to communicate with them at this point. You may want to try to convince your top programs to rank you as highly as possible, but you also do not want to mislead anyone.

The program may reach out in some way. They have the power in this

scenario, and they will use their power to try to convince their top applicants to

rank them as highly as possible. DO NOT CHANGE YOUR RANK LIST

BASED ON THIS INFORMATION.

TIMING: Most programs make their rank list 1-3 weeks before it’s due.

Make your move before this.


The rules: Rule #1: Follow the rules set by NRMP

• Programs can’t ask you specifically about your rank list

• You can’t ask programs where they’re ranking you

• Both parties ARE allowed to volunteer this information to each other Rule #2: Never mislead a program about your rank list. The most common example is telling multiple programs you ranked them #1.

You will not be able to hide from the truth once the match results are released.

If a program thinks you lied to them, you can forget about any future

opportunities there (fellowship, faculty positions, etc). Important Tangent: This rule also prohibits ambiguous statements such as

“at the top of my list.” It is too easy to misinterpret this as ranking that

program #1. In addition, program directors weren’t born yesterday. Most will

interpret “at the top of my list” as NOT #1. If a program is not your #1 choice,

sincerely state your strong interest in the program, but avoid any specifics

about where you ranked them. Rule #3: Programs like applicants who like them The reality: For most applicants, once interviews are finished, your position

on a program’s rank list probably will not change no matter what you do.

That being said, tactfully executed strategies may move you up on a

program’s list, and certainly will not hurt your chances. What you can do: These steps need to be done 3-4 weeks before the rank

list is due Ask faculty at your institution to advocate for you. General Surgery is a

small community, so a trusted colleague advocating for an applicant has the

most potential to help. Reserve this for your #1 choice. When deciding

whom to ask, the ideal faculty advocate should:

• Know you well and think highly of you

• Have a personal connection to the program director, chair, or institution

• Be well-respected as a surgeon Admittedly, it is difficult to find an advocate who meets all three criteria. That

being said, remember that any advocate who knows you well and thinks

highly of you has the potential to help. At Tulane, receiving support from the

Chair is the ultimate support at this time in the form of a phone call or email.


Send an email to the program director: Directly communicating your interest

in the program is a crucial step (see Rule #3), although it is admittedly lower

yield than having faculty advocate for you. Think of it as a “box to check” for

your top 3-5 programs. Emails need to be succinct and sincere (see Example

1). Specific instructions are outlined below:

• For your #1 program: State in no uncertain terms that you are

ranking them #1

• For programs ranked #2-5: Sincerely state your strong interest in the

program, but avoid specifics about where that program is on your list.

For example, do not tell your #2 program they are “at the top” of your

list (see Rule #2). Responding to messages from programs: Programs will sometimes throw

you a bone. Typically, this happens after they have made their rank list. The

program director will contact you and tell you anything ranging from “we were

very impressed with you” to “you’re ranked to match.” Here are some pointers

on how to react to this:

• Take everything with a grain of salt. If a program is reaching out to

you, you know they like you. The question is: how much? Applicants

tend to rank programs more highly if they think they were well liked

there. Programs know this, and often tell many applicants (not just their

top 10) that they were “very impressed” with them. Again, DO NOT

LET THIS AFFECT YOUR RANK LIST.

• Respond promptly (within 24 hours). Delays in responding make

you appear uninterested and leaves programs feeling slighted (see

Rule #3). If contacted by email, respond immediately. If contacted by

phone, let it go to voicemail first. Then, listen to the message, think

about how you’d like to respond, and then call them back.

• Be positive in your response. Even if that program isn’t in your top

3-5, you need to convey sincere interest in the program. If they

ranked you highly, you want to keep it that way in case you don’t

match in your top 3-5 (see Rule #3).

• Remember Rule #2. You should definitely tell your #1 program that

you’re ranking them #1. For everyone else, tell them you’re sincerely

interested, but avoid any specifics about where you are ranking them.


Example 1: Emails Sent to Top 3-5 Programs: Dear Dr. _________ (program director),

I hope this email finds you well. < I wanted to let you know that I will be ranking ________ #1 on my rank list. > OR < Having finished interviewing, I continue to be greatly impressed by __________. > The strength of clinical training and research opportunities clearly set the program apart from others. It

would be an honor to have the opportunity to train at such an

outstanding program, and I hope to receive strong

consideration for a residency position. Thank you again for your time and consideration. I hope I will

have the opportunity to work with you in the near future. Sincerely,

___________

Example 2: Responding to Email from Program Director Email Sent From Program Director to 30+ Applicants (why you

should take everything with a grain of salt): Dear ____________,

Thank you very much for taking the time and effort to visit us

in __________ and learn about our program. All the faculty and

residents were greatly impressed by you and your

accomplishments. We all thought you would be a great fit for our

program and could do very well here. I hope you will seriously

consider us for your future surgical training. Feel free to

contact me if you have any questions about our program. I hope you have a Happy Thanksgiving,

______________ (program director)


Email Sent from Program Director with Reply (if program not ranked #1): Dear ___________,

I wanted to thank you once again for your interest in our

program. All of us who met with you were thoroughly impressed by

you, and we would all be thrilled to have you become a part of

our program. I hope that we were able to convey to you our

eagerness and commitment to train and mentor you to become an

accomplished clinical surgeon and surgical scholar and to

achieve whatever goals you set for yourself. We plan to rank you as one of our top ___ applicants, assuring

that you will match here if you choose to do so. If you should

match elsewhere, we hope that you will consider us for future

fellowship training or faculty positions. We also hope that you

will keep us apprised of your progress, and that you will feel

free to contact us at any time if we can be of assistance to you

in any way. We wish you much success.

Sincerely yours,

____________ (program director)

–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––

Dear Dr. ______________ (program director),

Thank you very much for your message. I was greatly impressed by

your program during my visit. The strength of clinical training,

supportive culture, and breadth of research opportunities clearly

set ___________ apart from other programs. It would be an honor to have the opportunity to train at such an outstanding program.

Sincerely,

___________


Integrated Programs

Applying to Integrated Programs

There is a growing trend toward integrating general surgery residency and sub-

specialty training. Currently there are integrated training programs in plastic,

vascular, and cardiothoracic surgery. As many of these integrated programs

are highly competitive, applicants to these programs should take into account

many specific considerations that differ from applicants applying solely to

general surgery programs. The decision to apply to integrated programs and

the approach to doing so is nuanced and should be discussed with faculty

mentors, but the brief guide below covers some of the highlights. Getting your application ready:

• TALK TO YOUR PROGRAM DIRECTOR to determine whether you will

apply only to integrated programs or whether you will apply to both

integrated and general surgery programs. • It is completely ok, and very common, to apply to general surgery

programs in addition to integrated programs; however, in this case

you should: o Have two completely separate applications- one for your general

surgery and one for your integrated

• This means SEPARATE personal statements • If possible, have different sets of letters of recommendation

o For example, having 4 letters of recommendation all

from plastic surgeons looks suspicious to general

surgery programs. o Having some general surgeon letters in your integrated

application will not hurt you (but it is helpful to have

some letters from faculty within your integrated field) • You should never apply to both the integrated program AND

the general surgery program within the same institution

because programs may see this and you will lose out in both. • For your general surgery application, you will still need the Chair of

Surgery letter o Err on the side of full disclosure and be completely honest during

your meeting with your Chair, letting them know you will be

applying to integrated programs.


How to choose which and how many programs to apply to: • Again, review your resume with faculty mentors within your integrated

field and the Chair so they can gauge your competitiveness and give

you advice tailored to you. • Always overapply and cast a wide net- interviews are very difficult to

schedule, and especially with integrated programs they may only offer

one or two dates, so if you apply to 40 integrated and 40 general

surgery programs, you may only be able to schedule 9 integrated and 3

general surgery based on your competitiveness. Difficult scenarios during interview season:

• Integrated programs may think you’re also applying to general surgery

programs, and many of them would say you would be crazy not to, so

do not worry if they ask you about this, just BE HONEST • If your general surgery application is suspicious for you having

applied to an integrated program (heavy vascular or CT research

projects, multiple letters of recommendation from vascular or CT

attendings, personal statement, etc), you WILL get asked about

whether you also applied to integrated programs o If this happens, DO NOT LIE. Tell them the truth but follow with why

you decided to apply to general surgery programs too and use this as

an opportunity to mention why you applied to their program specifically • You may be advised otherwise, but it is typically not recommended to

volunteer the fact that you are an integrated applicant in your General

Surgery interviews. Some programs will not rank you if they specifically

know that you are dual-applying. • Be ready to answer the question: “So, is general surgery your

backup?” (The answer is NO, even if in your case it is…). This is a fine

line between not lying about dual applying and putting your best foot

forward on the interview. Though they may be a “backup,” you applied

to the program because you would be interested in training there if

your integrated Match does not work out. Frame this in your mind

appropriately and do not go into these interviews lukewarm. Other

people are trying their hardest to Match there, and you should too!


On the interview trail: • You will be interviewing with the same 20-40 people at most places

o Making acquaintances/friends quickly can relieve some of the

financial burden of interviewing- share Ubers, etc.

o These friends will be a part of your field for your entire career; you are

all in this together! • NEVER say anything negative about any person or program, as this

will come back to you because the circle is so small (although you

should never do this anyway) • HAVE FUN! Interviewing is awesome because you are networking with

great faculty across the country. Make a good impression regardless of

your interest in the program because it really is a small world


Sample Personal Statements

My first encounter with surgery occurred when I was in sixth grade. One

afternoon in February, I developed back pain that rapidly worsened over

the next several hours. My parents took me to the emergency room, where

a pediatric surgeon was consulted and brought up the possibility of

necrotizing fasciitis. Exploratory surgery confirmed the diagnosis.

Postoperatively, I developed septic shock and went back to the operating

room twice for further debridement and wound closure. Although I was

only eleven at the time, the experience sparked my interest in surgery.

Later in college, as I considered pursuing a career in medicine, I often

thought of the doctor who had performed the surgeries and managed my

care. These efforts allowed me to make a complete recovery. My family

and I were able to return to our normal lives. I wanted to have this

kind of impact on the lives of others, and that was my motivation for

pursuing a career in medicine. Once I entered medical school and began considering different

specialties, surgery seemed like a natural place to start. Not

surprisingly, I was initially drawn to how surgeons treated the most

critically ill patients, and the potential impact they could make on the

lives of these patients and their families. During my clinical

rotations, I was also impressed by how surgeons took ownership of

patient care, from preoperative evaluation to performing surgery and

managing postoperative care. Having trained as an engineer during my

undergraduate studies, I was also drawn to the methodical, data-driven,

and results-oriented approach of surgery. The strongest impression,

however, was made after I reflected on the diversity of surgeries I had

scrubbed during my clinical rotations: laparoscopic appendectomies,

below-the-knee amputations, liver transplants, Whipple procedures.

General surgery was the only residency program that would provide me

with such a broad base of clinical training while allowing me to

visualize pathology with my own eyes and correct it with my own hands.

At this point, I already knew I wanted to work with critically ill

patients – now I knew this was the way I wanted to do it. Throughout my clinical rotations and research, I found that my

undergraduate training in chemical engineering has been one of my

greatest strengths. It provided me with a strong foundation in

leveraging scientific fundamentals and statistics to objectively inform

decision-making. As with surgery, engineering was also team-based and

results-oriented with a focus on effective communication. From a

research perspective, I was able to utilize this foundation throughout

the research process, whether it was coordinating and training a team of

my peers to collect data, drafting manuscripts and responding to

reviewer feedback, or presenting findings at surgical conferences. I

look forward to continuing to build on this foundation at the next level

of training. Looking towards the future, my goal is to become a specialized surgeon-

scientist at an academic center with an active role in clinical

practice, research, and teaching. Ultimately, I hope to make the most of

my career in surgery, whether it’s providing care to patients, improving

clinical practice through research, or training the next generation of

physicians.



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Sample Interview Questions

CV questions: - Tell me about your research; what journal was this in? What did you find? - How do you stay involved with your hobbies in New Orleans? - Tell me about your leadership - Tell me about (hobby) - Tell me about (activity from cv) - What have you learned from your research experiences - Tell me about your leadership experiences - Tell me about what you learned from your research - Tell me about what you learned from your mph years - Very detailed questions about your research (what datapoints did

you get form UNOS? Where did you get donor data? Why did you choose to use alemtuzumab as an induction agent in this transplant paper?)

- What was your favorite project you worked on and why? Vs what was the hardest research project you worked on and why?

Role- Playing/Scenario Questions: - What would you do if you were the PGY2 on the team and your chief was screaming at the med student and you felt it was unwarranted? - What would you do if you came for sign-out in the morning and the night resident was nowhere to be found and now you're unprepared for rounds and your team is mad at you? - Pretend im a 75 year old man with a mass at the head of the pancreas. Talk to me. - Pretend im a patient POD3 from a vascular graft and now I have an ischemic limb. Talk to my family about what we should do. - Your pager goes off 3 times. One is a 6hr post-op chole in the PACU with a nurse complaining of nausea/vomiting and incisional pain. One is a Medicine resident calling from the floor with an active GI bleed. One is a floor nurse calling about a 12 hour post-op thyroid with some shortness of breath. Who do you go see first? What are your steps in decision-making?


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Personal Questions:

- Who are your role models? - What’s the coolest thing you’ve ever done? - What is your greatest achievement? - Tell me about a time you’ve worked with someone difficult? - Tell me about your leadership style? - Which rotation do you think you’ll like the least as a resident? - What motivates you? - Give me three things to tell the ranking committee about you. - Tell me something that’s not on your CV. - If you couldn’t be a physician what would you do with your life? - What’s your ONE biggest failure? - Why did you go to medical school - Do you think having a parent as a physician influenced your decision to be a doctor? - Why surgery? - If you couldn’t be a surgeon what would you be in medicine - So why not be a _______? - What’s your favorite operation/case? *Be able to describe it* - What would you change about Tulane? - What would you add to the ___community? - What would you do if you couldn’t practice medicine that you think you would also be equally good at? - Tell me about a case that was meaningful. *Again, be able to describe it.* - What’s your favorite book? - Tell me about a time someone was difficult to work with and what did you do about that. - So residency will obviously be stressful talk about a time you handled stress in medical school. - When was the last time you cried? - Tell me about a team that you’ve been on for longer than 4 years, and a challenge you’ve overcome together? Cannot be family


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Tough Questions:

- Immediately: “So what questions do you have for me?”

- Why would I pick you? - Why would I pick you when you didn’t come here for college/med school without a regional tie. Why would I believe you want to come here now? - I already know people like the outdoors here- why else would you want to come here? - I think your research is questionable don’t you think? - Who is your favorite surgeon in history? - Tell me about people you don’t like to work with and how you handle them. (While not particularly “tough” this one is hard to answer because it is basically asking you to complain. Be positive!) - Why is your Step score low? Didn’t Honor surgery clerkship? Not AOA? Aspirational Questions: - What are you looking for in a residency? - What type of surgery do you want to practice? - Where do you see yourself in ten years? - We have two research years here: what would you do with them? - Would you want to continue doing outcomes research or basic science? - What do you hope to do with your other degree (if dual-degree student)? Quirky Questions: - Teach me something interesting that I don’t know about or tell me something funny. - What would your patronus be? - What house would you be in in harry potter? - What character would you be in the wizard of oz? - What’s the spiciest thing you’ve ever eaten? - What superhero would you be? - I see you have exercise listed as a hobby, did you workout this morning before the interview?


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Illegal questions:

- Why would you pick ___ over Tulane? - Are you interviewing at (place you did an away)? - Why would you come here instead of there? - Where else are you interviewing? - How many other interviews do you have - How many interview offers did you get, how many are you going on, and how many are you ranking? - “Do you have a boyfriend?” - What are your top 5 programs? - Are you planning on having children in residency?


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surgery residency

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