A Practical Guide to the Psychiatry Match with Dr. Lia Thomas

[00:00:00] Welcome back to Psychiatry Boot Camp. Today we are having a timely discussion on the psychiatry residency match process, and my guest today is Dr. Leah Thomas. Dr. Thomas is the perfect guest for this topic for a few reasons. Number one, she is an associate program director, APD, focusing on recruitment at UT Southwestern Medical Center in Dallas.

Dr. Thomas also serves medical students as the co-lead specialty advisor for med students at UT who are applying to match into psychiatry. And finally, most importantly for my personal relationship with Dr. Thomas, she's one of the co-chairs for the Psychiatry Residency Application Advisor Group for ADAMSEP, which is the professional organization for directors of medical student education and psychiatry.

So Dr. Thomas leads a group for those of us who are in this match student advising role so that we can share information, best practices, at times commiserate. It's a [00:01:00] bit of a group therapy session on how opaque the match is. And then we also sometimes have discussions on how to improve the process. Dr.

Thomas, what else would you like to add to this introduction? Um, thank you so much for the warm and wonderful introduction. I think I would just like to say, um, I love being a psychiatrist and I love being a psychiatry educator and this sort of niche experience of thinking about sort of getting folks to residency and supporting through the process has been a real passion of mine over the last several years, and I'm really excited to have this conversation.

So thank you again for having me. Awesome. And I, I should mention as well that you're a professor of psychiatry down there at UT South Western. Um, and then finally, I-- This is my third year in what we call the primary specialty advisor role. So the way that I explain it to our M-threes is I sort of hold your hand through the match process if you're going into psychiatry.

So I hope that my audience and you will excuse me if at times I sort of step out of the host role and opine myself on this process. Absolutely. Let's come out of the gate hot and talk about increasing [00:02:00] competitiveness in psychiatry. Is psychiatry becoming more competitive? Put another way, is psych the new derm?

Ah, that is like the phrasing that always exists out there, um, psych is the new derm. I don't even know who coined that term. Um, I, I will say no, it is not the new derm, n- not because dermatology is its own specialty with its own special requests and requirements of students. Most people are thinking about psychiatry, not necessarily thinking about derm in the same way, and so but we are as a specialty getting more competitive.

Um, there are a lot of factors to that. We are talking more about the fact that people are more comfortable talking about mental health. NAMI has a wonderful campaign, It's Okay to Say. We've been more holistic in our recruitment of medical students, and so they may be more drawn to careers in psychiatry.

And so there's more people coming into medical school interested in psychiatry, which then of course increases kind of the demand there. So are we becoming the new derm? I don't [00:03:00] think so. But psychiatry is in this wonderful place where we are needing pe- people are wanting to do more psychiatry, and we definitely have, as a society, just a great need for more psychiatrists.

So this is a good, this is a good problem to be having. For sure. I, in 2015, dating myself, I was the first cohort that took the MCAT with that new section on like psychology and social sciences, and I've always wondered to what extent recruiting people who had to study psychology more in undergrad and prepare more in psychology and social sciences has led to increased interest in psychiatry.

And when I think about competitiveness and what I tell my students when they look at residency programs is look at the breakdown of US IMGs, IMGs, DOs, allopathic MDs, and traditionally speaking, and we can talk more about this Uh, allopathic students in the US have the highest match rate and are sort of considered the most competitive, and the proportion of US MDs matching into psychiatry has grown over the last, say, decade or so.

So I think that's, it's, it's very s- it's very, [00:04:00] um, we have excellent data to suggest that psychiatry has in fact become more competitive, but we're still a long way from derm. Yes. I think again, and you have to think about lifestyle factors. What are the other reasons people are choosing this? Derm was never on my radar.

Uh, shout out to my colleagues who are doing derm, shout out to my dermatologist. Um, but not the thing I was thinking about and never thought, put them in sort of the specialty of like these are the most competitive. Psychiatry, of course, has also been, and we'll probably get to that a little bit later, one of the beloved backups, which we now refer to as parallel plans, and we'll talk, we can talk about that as well as sort of like the change from being a specialty that sort of was like, "I'm not sure if I'm gonna match, so maybe I'll also apply to psychiatry to make sure I have chances to-- I need to make a backup plan for psychiatry match because this is harder this year."

I've had many a seasoned professor or supervisor tell me that they just wound up in psychiatry because they didn't match into their number one, and I, I, yeah, it does seem like that ship has now sailed. Yes, yes. I, I would not say you, you can't use psychiatry as a backup [00:05:00] and, um, you may need to think about a parallel plan, and that's actually really the, the better and more preferred term we think about now is thinking about a parallel plan.

It sounds better. It is a better thought, um, for students as well, making that identification of like, okay, I often sell it as I need you to have a job. You've spent a lot of time and money in med school. Let's think about a job and a career. And we can also talk about like the pathways. They-- Just because we're saying that we want you to have a parallel to psychiatry does not mean we don't think you'll make an excellent psychiatrist.

It just may mean that there are factors in your individual application that make us concerned about your success in the Match, and we need to think about how to make sure that you are successful at the end of the Match and leave this process and graduate with a job at the end of this. Okay, so let's talk strategy in terms of not being unemployed after medical school.

Here's the million-dollar question, and actually the latest data we have, twenty twenty-two from the AAMC, this was over a one hundred million dollar question. That's how much the [00:06:00] AAMC took in in revenue from ERAS alone in twenty twenty-two. How many programs should applicants apply to? Ah. Um, this is comical, and I'll, I'll tell a little story as I say this.

I just had a daughter apply to college, and unfortunately, the same advice I gave her is the same advice I give my student advisees, which is, "It depends." So there are a lot of factors. There is not one specific number. We often think about buckets of numbers for students. Things that have also changed that number are also, again, competitiveness over time.

I will also take a moment to date myself. I graduated from med school in two thousand and three, and I applied to ten residencies. And I know that there are s- people listening to this looking at me going, "That is amazing, and I kinda hate you." And I don't blame them. That, like, that's a very, very different process than what we're recommending now.

Um, so I applied to ten residencies and, and literally the advice I got from the seniors who were graduating just above me was [00:07:00] w- was, "That's what the first application fee pays for," and so that's how many places I applied to. We have had a change in the numbers over time. Um, we had students applying to as many as a hundred programs about four or five years ago, and that was expensive and really challenging for them.

Um, with the introduction of signals into the mix of the match process and the, um, ERAS application process, that number has been trending downwards. So psychiatry right now for this match cycle recommends it has ten signals for students. Um, what we are recommending at the most for students is I would recommend no more than fifty applications.

Um, and then I would say less than that would really depend on other factors for students. If someone is a high academic student, um, has done incredibly well on their clerkships, opportunities there, I would probably tell them thirty applications. If you're somewhere in the middle of your class, I would think about thirty to forty, maybe forty to fifty, depending on [00:08:00] sort of what activities you have, how does the rest of your application look.

Again, most psychiatry programs are engaging in holistic review. We're not just looking at your grades. We're looking at the volunteering opportunities. Did you-- You know, where, where were you, like, exposing yourself to psychiatry and your clerkship experiences? Um, but typically, conventional wisdom right now is really pushing us to say no more than fifty.

If you're a student who's got some academic bumps and bruises, it might be fifty with a parallel path as well. Okay. So y- when you get to that 50 number and y- for you, if you're, rather than saying, "I think you should apply to 100," we say, "Let's, let's think about a parallel plan." Yes. Uh, the, the data is actually, we, we ran some data internally in our own program, and the rate of return is the issue there.

The question really becomes, yeah, you can apply to 100 programs, but does that get you to the number of interviews you need to match? And that's, again, the other kind of question of the day. The folks at Thalamus and I had a conversation, and, um, [00:09:00] they, they don't like what we're doing. Uh, so I'm gonna put that in parentheses there.

One of the things we've been often doing is looking at the NRMP data at where is the number kind of like likelihood of matching. And for the last several years, psychiatry's been sitting at between 10 to 12 interviews. And so we're often telling our students, if you can get 10 to 12 interviews, then you are like, again, that slope of that curve hits like just right under the 100% likelihood of matching.

The question is, how many places do you need to apply to to get to that 10 to 12 interviews? And that's where we're thinking about 50 places. Um, again, throwing more places out there isn't necessarily going to get you what you want. It's hard because students don't wanna hear that. Um, I, I often get students who fight me and go, "Well, I'll just apply everywhere."

Now, I will also put a, a little asterisk caveat on that. This is for students who are applying by themselves. If [00:10:00] you are a student looking at a couples match, a whole bunch of math changes because you're not just thinking about your match, you're thinking about your partner's match, what specialty is your partner matching into, and that math and calculus changes.

I really recommend that those students talk to each other, talk to each other's specialty advisors, have really serious conversations about that. Um, that's just, it just makes it more complicated. It's not impossible. It is actually fairly common, um, but it just needs to be a different kind of conversation there.

See also comment number one, it depends. I feel like so much of this conversation, the answer is it depends, right? And you and I are both advisors at allopathic medical schools in the US, right? So if that's not your circumstance as an applicant, that probably affects your application as well. I always talk to my applicants about knowing your application, knowing how competitive you are and for what regions, and then knowing what your goals are.

So if you're an outstanding student and your goal is to match right here at SLU, then you probably need to approach your [00:11:00] number of applications a lot differently than someone who really wants to match in California, for example. So I think it depends is, is a very fair answer to that, but I do appreciate you kind of putting a flag in the sand there at a certain number and being specific 'cause I think that's gonna be really helpful for our listeners.

Absolutely. Thank you. Let's dive into signals. Why do signals exist? How many signals do psychiatry applicants get? And how should they think about using their signals? Ah, that's a really, really great question. So signals have existed For, uh, I'm trying to think of the numbers. So they used to be called tokens, which is a horrible, horrible choice of words.

Um, and that was the ENT initial sort of, um, description of it. They were using it initially. Um, it was then folded into the AAMC's processes, initially offered to just three specialties. I believe it was internal medicine, a pediatric subspecialty, and again, ENT, um, was doing this, and then offered to the broader process here.

I'm gonna p- let people peek behind the, uh, hood a little bit. How we've came upon the number of psychiatry signals in [00:12:00] the first iteration was really more art than science. It was sort of the AAMC approaching leadership at the National Training Directors organizations and being like, "Well, given how many students you have and this, like five sounds good.

Do, do you wanna do five?" Um, it was not. People are often like, "What was the science? What was the this?" It was like, "Five sounds good. Do you wanna go with five?" And we're like, "Okay, we'll try five." Um, and that's what we did for a couple of years. Um, specialties have very variability in this, so there are just small number of signals, which is often kind of five, six.

Then there's mid-tier, 10 to 20 signals. Then we think about large-tier programs, large-tier specialties, excuse me, um, which are, like, 30. There's also tiered signals where there are specialties that are doing gold and silver signals. When we've decided as a specialty if we wanted to increase or decrease, we've actually, um, recruited, um, and surveyed the membership of the National Training Directors group, ADPERT.

The first time we show-- talked about signals, we just stayed at five because that was what the membership wanted. [00:13:00] We actually voted again this year in 2020, uh, six at the end of the match cycle, um, and asked membership would they like to go to 10 to 15, and the membership actually voted overwhelmingly to stay at 10 signals.

So psychiatry medical students have 10 signals. Now, here's again where things get complicated. I'm sorry again. Per the AAMC, the actual wording is, "Please identify-- Use your signals to identify places that you are interested in But if you ask a medical student or a residency program, what does a signal mean?

You may get a lot of different answers. Um, some people go, "This, I'm telling them I'm going to, I wanna rank them for match. I'm telling them that I really wanna interview here. I'm-- They're telling me that they're my first choice. They're telling me..." Again, the wording on the AAMC is, please identify programs that you're interested in.

And the other important thing is that actually, um, the AAMC actually [00:14:00] strongly discourages programs from using that signal in their ranking decisions because there is a lot of time between an interview and match day, and what a student may have signaled very early on and having gone through the interview process may not be their choice anymore.

They may have interviewed at a program and gone, "Oh my goodness, I didn't even know this was on my radar, and now I really love this place, and, like, they love me, and it's great." So it is actually highly discouraged per the AAMC to actually use a signal in ranking decisions at the end, um, recognizing that that changes.

So students get 10 signals. So students get 10 program signals And when we're thinking about how they should use these program signals, the AAMC says choose programs that you're interested in. And when I hear that, I actually hear the same advice that we get from the NRMP on how to approach the match algorithm, which is rank in order of true preference.

But I know from our advising sessions that simply choosing the 10 programs that you're most interested in going to as your signals is not [00:15:00] always the optimal strategy, at least I don't think it is. What do you think is the optimal strategy for approaching these 10 signals? I think it's a combination of factors.

Um, the way we often advise students here is I, I like to think about it as a layer cake process. So I think about signals and I also think about the geographic preference. Psychiatry is a unique specialty in that we're really interested in the geographic preference. And so I often recommend that students, if they can, they cluster their signals with their geographic preference.

So if they, for example, are interested in Louisiana or programs in Louisiana, Texas, and Oklahoma, that's actually my geographic region, and they're gonna signal places there too, it kind of boosts the experience and sort of shows a program you really, really, really, really wanna live here. So that's something I think about.

I think this is where looking at the available data, so using things like AAMC's Residency Explorer, and if your medical school has access to this, the Texas Star. [00:16:00] Shout out to my colleague, Dr. Angela Michalek at UT Southwestern. She's the one who created the Texas Star. So that is a massive database of self-reported data from students that said, "Here's where my scores were.

Here's the places I interviewed at. Here's the places I ranked at." I recommend using those in tandem because the Texas Star is self-reported data and Residency Explorer is actually data from the major institutions, so it's NRMP, AAMC, it's actually AOA data's in there. Um, and when I say AOA, I mean osteopathic medicine data is in there, all of those features.

So I recommend using those in tandem to see, okay Here is who I am as a medical student. Here are the places other students have gone before me. I am also looking at, I want to stay in Texas, I wanna stay in Louisiana, I wanna stay in Missouri, and then kind of build the list based on that. I recommend, um, many people have heard me say this, I do not recommend making your signal list based on the first page of [00:17:00] Doximity.

Note I do not say the best programs because there is no such thing as the best program. Retweet. Best program. You know, the, the best program is the program that you got into that feels like it works for you, and you graduate from residency and become a competent and excellent physician. But again, some people often think, oh, I need to signal the first page of Doximity, and that's what I

And I'm like, I, I would not recommend that as a strategy unless you are the second coming of Freud. So, and even then, there might be some concerns in 2026. Yeah. Right. So maybe- Yeah ... maybe think about it. Um, so, um, thinking about program signals, I'm gonna summarize kind of two key pieces of advice here. One, you are actually recommending to consider stacking the geographic preference and the program signals to really signal I'm very, very interested in this program.

You're ... Not only are you in my geographic region, but I also gave you a program signal. And then to put it bluntly, I'm gonna say be realistic about your signals, and think [00:18:00] about return on investment, right? Do you want to signal a program that is gonna get Way, you know, that these top so-called top 10 programs on Doximity, they're gonna get a bunch of signals from very competitive applicants.

You might not get a very high return on investment if you burn one of your signals there. So you, I, I talk about bang for your buck with signals. I think again, it gets to knowing your application and being realistic about where you want to be and how competitive that particular program will be. Right.

Exactly. I think it's important to emphasize to students, and even advisors listening, a signal is not a guarantee of an interview. A signal is also one piece of a holistic package and process. And so thinking about this, like, holistically is a thing. You know, there are sometimes we have seen students who have really challenging academics.

They may not meet the minimum threshold of that medical school residency program they're applying to. You send a signal to a place that, like, p- per Residency Explorer, you didn't meet criteria for, they are-- [00:19:00] that, that signal is not gonna, unfortunately, ignore the fact that you may have had a shelf failure or a step failure.

And so being realistic about that can be really important. Yeah, and knowing the research, knowing what the data says, 'cause they do have-- we do have data available to us, because I'll just say as an advisor, your advisor cannot possibly track this data for 200 programs. So it really is up to the-- I had an applicant sit in my office, I think it was yesterday, who I gave some advice to, and he was like, "Well, Texas Star actually says..."

And I was like, "Bro, you're more prepared for this conversation than I. Like, thank you for teaching me." There you go. So, you know, applicants really-- people are gonna have interest in different programs, and so an advisor can't possibly track all those metrics. No, no, no. It's definitely, definitely hard, and there's a lot of data out there.

Let's talk about how a program director might evaluate an applicant in this increasingly competitive environment. You know, given the weight of this process, I think there are surprisingly few key data points that program directors have on applicants and vice versa. So I'm gonna list a few of these data points that a program director gets from an applicant's ERS application, and I'm going to list these data points in [00:20:00] my personal perceived order of importance.

And then I'd like for you to give me your ranking, and we can talk about strategy for each one. Okay, good. So here's my ranking. Step two scores, clerkship grades, personal statement, meaningful experiences, letters of recommendation, and then research experience and publications. So this is gonna be-- this is an asterisk, uh, because I disagree.

Great. I disagree. Great. Um, and I think, I think this is where, like, the individual program is going to make a difference because certain programs are gonna wanna look at some things, some programs will look at others, and so this is where, like, what does the program prioritize? Like, this is where going to the website, like scanning their Instagram, scanning their Twitter, is gonna be really important because those are the things they value.

Like, "Oh, hey, they talk about research. Oh, hey, they talk about [00:21:00] this." I'm gonna... Can I give one more asterisk too before you- Please ... tell me that I'm wrong? Yes. Yeah. I think that I, I tell my students that this is what matters for getting an interview. I don't think this is what matters for matching. I think what matters for matching is strictly interview day.

But when, if I'm a program director just screening applications for an interview, that's my ranking. So that- Okay ... that's, uh- So, okay, for screening, okay. I will tell you clerkship grades, meaningful experiences, Step 2 scores, well, maybe. I'd put personal statement above Step 2 scores Research and experience if they're going for the research track.

Um, and letters of recommendation are dead last. I love it. I say the same thing about letters of rec, and that's a hot take around here, so thank you for that. It's a hot take, but like, like, it, some- sometimes the letter of recommendation speaks more to the letter writer than it does the student, and so, like, we take those with like, okay.

Um, you know, like it's ... I, I can [00:22:00] reflect on some beautiful letters of recommendation, but those are far and few between. Most of them are very much a, "They were a great student. Here's what they did. They were great on the clerkship. They worked really hard." Th- that's most of the time what we see. The ones that get a little sideways, it's like, it's more about the letter writer than it is about the actual student.

I, I have definitely read some where I'm like, "You should not have asked this person to write you a letter. Oh, dear." Uh, but again, it, it speaks more to the letter writer than the, um, than the student itself. I think we're gonna go into personal statement, meaningful experiences, and letters of rec strategy in our second segment.

So a couple quick questions on, uh, follow, to follow up on this. So how important is research in psychiatry? It sounds like you would say basically not. Well, again, I think, uh, as always, it depends. If you are a student and applicant applying for a research track, which often are those students who were in their, um, [00:23:00] MD-PhD program in med school, or potentially did, had received a, a PhD prior to med school, if you know that you are planning to be a clinician scientist, you are planning to be writing your own grants and have your own lab, then yes, those, those research track positions and programs are looking to see what is the body of work you have completed prior to applying for this MD, you know, for this research track opportunity.

I think for the rest of us, the more ge- the general tracks, the categorical programs, we're looking at it as like, were you able to complete a project? Were you able to take an idea, complete a project, complete something on record, and kinda complete that through there? That's the through line I'm looking for, like, "Oh, you did this."

But, like, don't complete research f- you know, the, the advising I give when I meet with medical students earlier in their career, so I do a lot of advising, of course, in the fourth, you know, end of third through fourth year. But oftentimes I'm meeting with students, you know, when they're [00:24:00] first and second years, just wanna talk to me, and they're like, "What research should I be doing?"

And I'm like, "Research that interests you." But, like, please don't just do research 'cause you wanna write a paper. Like, do something that is meaningful, that is valuable, so that when a future interviewer is asking you about this research project, you can actually say, "Oh, yes, I was really interested in, you know, diabetes, in schizophrenia, and so I did this thing."

That's really cool. Tell me more about it. But as opposed to, "Oh, yeah, I did that thing. I don't really remember why I did it, but I put it on my CV 'cause I thought it was important." So do things that are meaningful and valuable. I think more about, like, depth of experience versus just pieces of experiences here and there.

Yeah, I'm often talking about think-- put yourself in the program director's shoes. What does the program director wanna see? And if I was the program director, which I'm not, but due to self-loathing, maybe someday, um. Um, I do not wanna see that you're really good at picking things up You know, you're really good at picking up 10 projects and getting, you know, like, but seeing that you can pick one project that you're passionate about and [00:25:00] see it all the way through tells me about how you're going to be as an employee, and I think that's an important data point.

Absolutely. Absolutely. I agree. What about away rotations? How important are away rotations in psychiatry? So I'm gonna speak from many hats here. Um, I'm gonna give a shout-out to my colleagues who are at our osteopathic medical schools because they often have a lot of challenges with this. And so I'm gonna make both a plug and a prayer for them.

Um, our osteopathic medical students do not often have a home medical school, so oftentimes they don't have a home hospital system, so they oftentimes really need these away rotations. So to my colleagues out there listening, um, please, please be kind. Give a DO student an opportunity to interview to have an away rotation.

It's really important. So I think that is a separate bucket, and, like, they really need them there. For more traditional US MD allopathic medical students, again, my favorite term, it depends. And, and here are some of the things it depends on. If you are incredibly geographically bound, for [00:26:00] example, I am the primary caregiver for a family member.

My partner has a job that is bound here, and we cannot financially support, like, we need this job. If there are geographic boundaries that are incredibly high, then absolutely you need to do an away rotation because you need to find those programs, really get yourself, you know, a, an away rotation is basically a four-week job interview.

So I think that's the other part of it as I remind students about this. So again, going back to this, if you are very geographically bound, I need to be in this city, I need to be in this metro Then I would recommend an away rotation so that you can actually potentially get face time with the program director, meet the residents, and tell the residents you really need a job here, all of those things.

If you don't have those kind of geographic boundings, I don't think it's necessary to do an away rotation. They are expensive. They're challenging. It's a lot of [00:27:00] work to get them done. Sometimes they don't align up with your own med school schedule. You may have to pay extra insurance to be o- like health insurance to be part of that rotation.

Uh, and again, it's a four-week job interview, so you effectively need to be on for the four weeks, the two, four weeks of that job interview. So while it could help you, there is always a risk that this could harm you as well. And so being mindful of that opportunities, uh, can be really important there. Um, so again, I really do preface it as like if the geographic boundaries are really tight, then maybe an away rotation is necessary.

But outside of that, I don't really recommend them unless it's something like that. Okay. Thank you for that, uh, answer on away rotations. I think that was very concise, and I agree with everything you said. One more big-picture question before we go to break. So when I interviewed for residency in twenty twenty, everything was in person.

So I went to eleven interviews in eleven cities. I spent several thousand dollars in student loan money to pull this off. That stunk. And that said, there, there is something about [00:28:00] seeing a place and meeting the people who will be training you. I highly doubt that I would have ranked Creighton Omaha, where I ended up doing my training, highly if I had only had a virtual interview there.

I didn't really know much about Omaha. But then I went to go see the program, and I was just crazy about it. So I think there is a real benefit to in-person interviews. Do you think that we will have virtual recruitment forever? Are there any plans or conversations about going in person? What might a hybrid approach look like?

What do you think? It's a great, great question. I am, and, and many of my colleagues who know me, um, know that I am very much team virtual interviewing for many of the reasons you just explained. It is expensive. If we're asking people to now do 10 plus interviews, that is a lot of time and money. Some of the federal government changes in loan structure may make this actually very challenging for upcoming students.

My shorthand answer is, why are we asking people who don't have money to spend money, is sort of my shorthand answer for that. The other thing that's real now [00:29:00] is that medical school interviews are almost exclusively virtual. So while we as program directors are still kind of bemoaning like, "This is not the way we used to do it," it is almost the entire way that the medical s- medical educations is happening.

So the medical students actually probably have more experience with recruitment in virtual settings than we do at this point. I really encourage it. I think it's a challenge. I completely recognize that my colleagues in smaller programs, smaller communities, may really struggle with how do I navigate, you know, how do I sell my program?

Um, and there's been a lot in the literature. We've talked about, like, updating our websites, social media, how do we sell programs? We've also talked a lot about second looks for students as a way to help them with maybe going to the three to four programs they'd like to go to. Really, like, two. Just go to two.

Don't go to any more than two. But, like, a couple programs that way. And I think that my colleagues on the recruitment side as program directors really are telling students, like, "You don't have to come." I, I feel like when I am, uh, doing my closing speech or during, [00:30:00] um, interview season, I feel like I am beating a dead horse of like, "This is optional."

We're not tracking this. "This is optional." Yeah. "Do not come." I do not know. I actually have no idea. My chief residents run the whole process. I just help with funding, and I have no idea who attends. So I really wanna stress that message. There have been conversations, uh, these also happen both at the psychiatry program level for some places, GME offices have been having this.

So our institution has specifically said, "You can have in-person or virtual, but if you have, you can have one or the other. You cannot do both. And if you have in person, you can't have a second look." So that was what our institution sort of gave us as guidance. You can have in-person interviews at your institution for some specialties?

For some specialties, they have gone back to in-person interviews. Wow, I didn't know that. Okay. Yeah, so some specialties are-- You might wanna, like, peek around your institution 'cause it's happening. I think some of the surgical specialties have been interested in, in kind of returning to in-person interviews.

The AAMC really recommends against hybrid interviews, and the reason for that is that [00:31:00] it's gonna bias students. Uh, it's gonna bias us and students as well. Like, I can't imagine if I were a medical student applying in this competitive atmosphere, and I was told, "You c- y- we would love you to come in person, but y- you can come virtually if you'd like."

Uh, I think I would absolutely feel the pressure to come in person. I don't think I would just be like, "Okay, well, they said it was okay." Our students are anxious and I think they would hear that and go, "This is the second-tier option. I'm not doing the second-tier option. I have to scrape up some money and fly all over the country."

So I definitely am against, um, hybrid, and so is the AAMC strongly recommends against it. I'm also Team Virtual because it's actually a lot easier on the faculty as well. Like, from an interviewing standpoint, um, I've created a day where people can either interview in the morning or afternoon, which means they're not sacrificing their entire clinic day.

People are really appreciative of that , um, as well. Also, if you're a satellite faculty member, you now have the ability to interview virtually to your folks as opposed to like, [00:32:00] "Hey, do you wanna drive 40 minutes from your satellite clinic to interview half a day on the campus where you don't may- maybe not have parking?"

Like, that's a real big challenge as well. I think it's an ongoing conversation in psychiatry. I think we need to just talk to all the stakeholders about it. There have been some conversations. I am a loud voice that's Team Virtual. I also recognize that my colleagues at some smaller programs are like, "It'd be nice."

We're trying to find a balance that works for everybody, but I, I completely think program directors alone can't make this decision. We absolutely need to have our medical students be part of this conversation and make sure their needs are being met as well. For sure. So for this year, all psychiatry programs are strictly virtual, but there have been conversations about maybe allowing programs to choose their own path.

Right. That might happen at a GME level is what's happening there. The ADPERT recommendations are that programs, uh, remain virtual recruitment, um, but we recognize that opportunities at your local GME may [00:33:00] change how you think about it. But for the majority of psychiatry programs, we've been recruiting virtually.

Okay. Sounds good. We're gonna take a break, and when we get back, we're gonna talk about strategy in terms of personal statement, letters of recommendation, meaningful experiences, and how to build your ERAS application.

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Okay, welcome back. So Dr. Thomas, I wanna ask you as if you were my advisor about how to approach different aspects of my application. So we're gonna leave board exam scores and clerkship grades aside, because by the time the student is [00:36:00] applying, that ship has mostly already sailed. Let's talk about personal statement.

What is your generic advice for students about how to write their personal statement? This is a great one. I think my generic advice is sort of who you are, why psychiatry What do you hope to do in a psychiatry residency? And if there are any academic bumps and bruises, maybe this is a space I can use to explain it.

But I kind of keep it very formulaic. I wanna hear a theme throughout that can be really lovely. Uh, I've heard students talk about their interest in geriatrics by beginning with a lovely story of their grandparents. I've heard people talk about the first time they were scared going into an inpatient psychiatry unit, but how valuable it was to really learn and see their psych- a psychiatry attending grow and help them grow, um, as a trainee as well.

But I think there's meant to be a theme and a flow to the process. I recommend they be one page. I'm a little particular about that. Sometimes we know that when it gets converted to a PDF, it sometimes rolls over, but, [00:37:00] like, it really should be a page. You should be able to succinctly describe yourself.

Something I will add for this era that we're in right now, please do not have AI write your personal statement. We can tell. Program directors can tell. They're really generic, and also they tend to have just, like, a lot of very, very, like, SAT-level words that most of us don't use in our conversational language.

I don't need to see a bunch of high buzzwords. I wanna hear you tell me a story about who you are. I think about your personal statement as me reading it going, "I can't wait to talk to you." Like, I kinda wanna talk to you and hear, tell, hear, hear you tell me more about this story is something that I think about when I read personal statements.

One of my pieces of advice that is stolen directly from my mentor at Creighton is if someone else could have written this personal statement, it's not personal enough. So I think encouraging students to, you know, be authentic in that way. And I had a student come into my office to review a [00:38:00] personal statement a few days ago, and the main question the student had was, "Is it too long?"

And on ERAS, on the PDF, it's about one and a quarter pages. And I basically said I thought it was fine, but I'm gonna actually go back on that advice now and tell this student to edit it. And because, 'cause here's the thing, there's only-- there are very few data points with which people screening these applications can judge applicants.

And did you follow directions is a pretty big important thing when you're hiring an employee. So when I think about, like, things that can kill your application, one of them would be, this is just for me personally, and, and I've noticed at these rank meetings at two different institutions now, people just have different things that bug them and that can sink your application, not following directions with being a big one, not coming to the pre-interview, whatever it is, right?

Like you're gonna have to go to 10 of those. They're mostly all pretty boring. You're gonna have to ask some fake questions, but you really do have to show up unless you have a really significant reason not to, in which case I think you need to prove that to the program director, right? Like We are asking that of you, and we are asking them to do a one-page personal statement, so I [00:39:00] appreciate that.

Yeah. Yeah, absolutely. Absolutely. And, or, and to that point about the missing things, just say you're, you're not available. People get ill, things happen, but just convey it with folks. Don't ghost people. This is a job interview, and I think that's something we should stress. I think sometimes people have been in the learner role for so long that they're like, "Oh, I'm just going to residency."

And I'm like, "No, no, residency is a job. You are actually a-- This is a job interview, and your application is your job application." And so remembering to put your best foot forward in all parts of this job process can be really, really important. How should students think about the 10 experiences that they include in their ERS application?

And then how should students go about selecting the three most meaningful experiences? Uh, really good question there. Um, again, they need to start with their whole CV. So I think it's really important to look at their whole CV, what is their life telling them? What are themes that are coming through? This is where working with an advisor can be really important because an advisor will be like, "Oh, hey, you've done a ton of [00:40:00] work in, like, our student clinic.

Like, you need to really highlight this." I would also wanna recommend, 'cause sometimes people have done things, like, for example, in a student clinic, maybe they started out as just a, like, I was just a student in the student clinic, and then I went to clinic manager, and now I'm doing this project within it.

Um, you wanna think about how do you-- do you wanna separate those out, or do you wanna clump them all together and then use kind of the space for the, like, hundred and I think it's 1,050 characters to use that space there to explain, "I started out just as, like, a volunteer in the student clinic, but then I became the clinic manager, and then I got a grant and built this part of the student clinic."

All of that together 'cause then you can-- that actually also gives you more real estate to then add nine more experiences. I think it's really what you wanna highlight of yourself. For example, there may be students who are interested in child and adolescent psychiatry. So again, there are-- The traditional path is I start with a general psychiatry residency, and then I choose to fast-track into a child and adolescent fellowship [00:41:00] at, at the end of my third year.

But there are also now a lot of combined child and adolescent, um, CAP programs. So maybe when you look at your application, what you're gonna highlight is all the pediatric and child experiences you have to really sell, like, I really wanna be a child psychiatrist, and I'm applying to your CAP program to really show you that I'm interested in this.

I think, hot take, um, uh, anything is psychiatry. Everything is psychiatry. Oftentimes, people feel like, "But I did this thing," and I'm like, "Well, you worked with the unhoused. You worked in substance abuse. Um, you found yourself, uh, in your research experience that you did more drawn to the people and their stories than you did the actual research."

Like, we can, we can find a way to, to pivot this and talk about your story. Again, this is where the work of, like, working with an advisor, someone you can sit down with and go, "Tell me how you got here. Tell me how you got to psychiatry," 'cause they can help you go, "Oh, I didn't even see that thread. Yeah, [00:42:00] man, let's work on that together.

Let's build that out." So those are things I kind of recommend for folks there. I think meaningful is gonna be based kind of again on that, like, working with your advisor, what things really stand out to you, what things about yourself you really wanna highlight. When you're telling your narrative, right?

Your application sort of tells a story, and so pulling those themes from that. I love that. So I, I think to paraphrase, personal growth is psychiatry. And in psychiatry, all of your-- all of the attendings have gone through a lot of personal growth themselves. We talk a lot about the importance of our own psychotherapy, and I think sometimes we use that as shorthand for maturing as a person and growing, I'll say spiritually and emotionally.

So if you can talk about what you've learned and how you've developed and, and learned about the human condition, you can do that in a lot of different environments. And I totally agree with you that any psychiatry attending, anybody reading application, is looking for someone who is emotionally mature, ready to handle the really difficult aspects of this job, like interfacing with people who are suffering, not due to a [00:43:00] chemical imbalance, but due to a failure of society to protect the most vulnerable and provide adequate housing, et cetera.

So I think that's a really brilliant hot take. I wanna actually go back and say something about personal statements. It's really-- That's come up a couple of times. We know that our students are also themselves can, and, uh, much like us as psychiatrists, are also accessing mental health care. And oftentimes a question we get is, should I talk about my, you know, the fact that I've been in student counseling?

Should I talk about the fact that I myself have some struggles? Get that all the time. Again, this comes back to the it depends. The important thing to remember is that your application is read by a lot of people, um, by the program coordinator, program directors, interviewers If you feel comfortable with all of those people reading this and asking you questions about it, and not to say, like, the questions aren't bad, it's really about how you are doing as a student.

If you feel like, "I had a mental health issue. I feel good about [00:44:00] where I am. I am healthy. I have fully absorbed my stuff. I can talk about this comfortably," then yes, it's okay to write about it. But if you're at a point where you're like, "You know, I'm still, I'm still in treatment. I'm still working through my stuff.

I don't, I don't know if I'm ready to talk about this," it is also 100% okay not to write about it in your personal statement. Maybe that's a conversation you choose to have with just the program director and say, "Hey, I'm, you know, I, I myself am getting, you know, mental health care. What are the resources for that?

Is that okay in your program?" It better be okay in your program. Um, sorry. But you know, like, but, like, that's the way to think about it. So I say that to say have a conversation with your advisor about that. I have read some beautiful statements where people have talked about their own mental health journey.

I have also read some things where people are anxious about it. I've also had students just come to me during the interview season and go, "I wanted to bring this up, but I wasn't ready to talk [00:45:00] about it." All pathways are okay. It's really about what you're comfortable with and how we can make sure as advisors that we're supporting you on that journey.

That's such a common question. I'm not gonna add anything to that. Thank you for that. Uh, I'm gonna mention two other things about experiences. One, this question comes up, you know, something like research, can I list research experiences all separately? Should I list them all together? And it sounds like your advice is whatever works best for your application.

You have a lot of flexibility in what you would consider an experience. Right. And also this year, so for the 2027 match cycle, there is a separate section on the ERAS form for research. So they actually- Okay, so research was a terrible example. This one actually- But something like working at a clinic. If you, if you worked at a clinic- Yes, yep

and you held multiple roles, you could list that separately or together. Yes. Yes. Y- yeah, but for this, this match cycle, they've actually added a section specifically for research that helps people kind of identify, like, I did a project, and I got a poster, a paper, and, like, three abstracts out of it, to kinda help kind of identify that work in a more structured way.

Can research [00:46:00] still be a meaningful experience this year? It can be, yes, but there's a space for, for research, so that gives you, again, think about your real estate. Like, now I have more real estate for other stuff, so that can be really important. Good to know. And then another one that I wanna mention is this has come up just a couple of times in meaningful experiences.

I personally advise to stick to Hmm, how to say this? Uh, there was an experience that I read one time that was, like, reading novels, and I could see where reading novels would be meaningful for your personal growth. But personally, I don't think that it belongs on a residency application in this professional environment, and certainly some other application readers that were discussing the applicant were almost offended that the applicant would treat reading novels in this way.

So I, I'm not gonna say it has to be a professional experience. I mean, volunteering, I think you could argue is sort of tangentially professional. But something like running, reading books, going for hikes, I probably would think about something like that more as a hobby than as a meaningful experience.

Would you agree with that? I would say [00:47:00] so, yeah. I think there's a space for hobbies, so you know, fill out the hobby section. It's very comical. Uh, the AAMC is slightly annoyed at all of us program directors because we really wanted hobbies back. They took it away, and we were all like, "Can we please have hobbies back?"

And they were very annoyed at all of us 'cause they're like, "There's no, like, data value." And a group of program directors were all like, "But we can ask questions." And this wasn't just psychiatry. Like, it was, like, internal medicine and surgery, and we're all like, "But I wanna ask questions about who they are and, like, what they're doing."

But I shouldn't say this, but, like, if you put Magic: The Gathering on your hobbies, I might ask you a couple extra questions because I have a household full of people who play Magic: The Gathering that drive me nuts. Um, so you know, like, uh, I can, we can talk about it and, and share together. Um, maybe we shouldn't put that in, but it's kind of fun.

Yeah, we should put that in. That's a cheat code for UC Southwestern, I guess, Magic: The Gathering. Right, exactly. Exactly. But you're right, and that's what hobbies are for, is they're, they are fodder for the interview. And I've had interviewers, and I think this is, personally, I think this is offensive as an interviewer, [00:48:00] that, like, will refuse to ask questions about your professional experiences and application 'cause they, they say, "I just wanna see if this applicant knows how to chat."

You know? But people have different interview approaches, and, and I think hobbies are really important in that way. Yeah, yeah. And I think that's a, that is a whole set of, that's a whole different set of interviews about, like, interview styles and what we should do, and there's data, and there's challenges.

Um, but yeah, I think going back to specific, about, like, should you have 10 As a specialty, just thinking about my conversations with colleagues and whatnot, no one has come out and been like, "Yes, I'm counting and making sure it's 10." I think if it's, like, noticeably short, we're all kind of going, "So what happened here?"

Um, you know, like sort of a, "Hmm, we only have three or one. What happened here?" Um, but I think no one is counting to make sure there's actually 10 either. Again, as the field becomes more competitive and we're getting less data points, maybe that will change. But at this present moment [00:49:00] in time, no one's sitting there being like, "It must be 10."

Um, but we're definitely kind of keeping an e- I would say we can keep an eye on it and see sort of what our colleagues think about in the future. Moving into letters of recommendation, how many? From who? And I was gonna ask how important these were, but we just talked about it, and I'm gonna paraphrase you and just this is what I say.

They all sound the same. They all say, "This applicant's great, they're super good, have been in a residency program," so I don't think they're very useful for differentiating between applicants for an interview. But what's your strategy recommendations for applicants? So, um, in terms of how many, the answer is please go to the website and look to see what the program is asking for specifically.

Most programs want three or four. I think the max is actually four letters for the AAMC. The max is four. But, like, please go and read the website and make sure, 'cause programs have said what their specific requirements are, and so please read the website and see how many you need. This is sort of a myth that keeps existing that is not true.

We sort of went on our, [00:50:00] like, advert list serve. Nobody is requesting a chair's letter. People keep asking, like, "Do I need a chair's letter?" Nobody is asking for a chair's letter. We, we literally, like, went hunting, and nobody's asking for a chair's letter. Now, if you happen to be someone who has worked directly with your chair because you're at a institution where the academic, where the academic chair is also a, like, faculty member who's teaching, bonus, right?

Get a letter of recommendation from that person because you worked with them clinically or you worked with them in the lab or something like that. But, like, don't get a chair's letter because you need a chair's letter because nobody is asking for a chair's letter from that standpoint. So again, read how many applications, three or four.

The kind of conventional wisdom is at least two from psychiatry, and then the other one or two letters could be maybe from a primary care specialty. Um, and again, this may be where you get kind of strategic. If you're thinking about child and adolescent or women's mental health, maybe getting a letter from OBGYN, maybe getting a letter from pedes, maybe getting a letter from primary care.

Those are all [00:51:00] great. Funnily enough, I was not interested in child and adolescent psychiatry, but I really liked my pedes rotation and had a good experience on it and really liked the attendings. So they wrote... I asked my pedes folks to write me a letter. I had internal medicine pedes and two psychiatry letters.

A big thing we often hear students asking about, and this has come up in, even in our advising group as well, is, "Well, do I need like a fresh letter? Do I need a letter from my sub-eye? To-- What if my clerkship was in July of last year?" All of those are okay. The question you need to be asking your letter writer is, "Do you think you could write me a good letter of recommendation?"

Notice I put the emphasis on a good letter of recommendation, not just a letter, a good letter. And yes, a good letter will still be like, they were fine, they existed, they were nice, but you want to make sure that that person isn't pausing and going, "Ooh, do I wanna write a letter for you? Do I remember you?

I don't know." Give people the opportunity out to say, "I don't know." If someone is a further back attending, you can-- and they say, "Yes, I'll write you [00:52:00] a good letter," also offer to meet with them. Bring a copy of your personal statement. Bring your CV. If you have your comments from the clerkship, bring those some.

Here's where I was. Like, let me tell you a story. Just get 30 minutes of their time. I actually have written letters, and I've literally actually, I actually do that. I actually do the opposite. I don't tell them, wait for the student to go, like, "Can I have 30 minutes?" I go, "Okay, we're gonna meet for 30 minutes so that you and I can talk through this, and then I can read your personal statement.

I can ask you some questions. We can jog my memory, and we can write this beautiful thing for you." So I think that's really important. Know psychiatry programs. There's also what's called a standardized letter of, uh, recommendation. This is what Adamsep has created. This is in response to the AAMC's Transitions UME to GME document.

One of the requirements of this document is that programs develop a standardized letter of evaluation or recommendation. A lot of people don't know that, and so folks are like, "Why are we doing this thing?" And so we're building a SLOR, um, is what the [00:53:00] process is. The SLOR is currently optional for everyone.

It's optional for letter writers, optional for students, and optional for residency programs. But we as a specialty are trying to move the needle forward, and I think Adamsep and Adpert need to keep talking more about how we're gonna develop this future for our, um, students to be using. Okay, thank you for the, uh, guidance on letters of recommendation.

And the one part that I'll underline is if you ask someone for a letter of recommendation and they give you a lukewarm answer or indicate in any way that they're not so sure about writing you a letter of recommendation, I really, really, really would encourage you as an applicant to find another letter writer.

No faculty member wants to tell you, "I'm not going to write you a good letter of recommendation," or, "I don't remember you." So I think you should take any hesitancy as a, "You know what? I'll just find somebody else." That would be my advice. Yes, I would agree with that. The other thing is faculty are human, so please, A, give us lots of notice as to when you need it.

Send us a gentle reminder because everything needs to [00:54:00] be in an ARIS. We wanna make sure your stuff's in. And also send a thank you note after. Those are all the things I would say. They're just, just nice customary things to do that will help your faculty member also in the process of writing you a, a solid good letter.

Million-dollar advice. Okay, let's move into Classic, quote-unquote, red flags. And I hate to use that terminology, but I really do think that's the vernacular. I think that's the way most people refer to this, so that's the way I'm gonna refer to it. And I'm gonna read these questions directly from the AAMC's ERS worksheet, and the instructions say that a yes answer to either of these questions needs to be explained by an applicant.

So this is kinda what I mean when I say red flags. Quote, "Have you ever had any academic extensions, leaves, gaps, or breaks in your educational program due to repeated or remediated coursework?" And then the other similar question, quote, "Have you ever had any professional extensions, leaves, gaps, or breaks in your educational program due to professionalism sanctions or any other adverse actions by your medical school or [00:55:00] its parent institution?"

So my question for you, if an applicant needs to answer yes to either of these questions, how do you advise applicants to approach the explanation? That's a really good, uh, question. Um, I'm gonna give kinda two answers for this. So I actually, I will say I like this question because sometimes it, it, it sort of separates out academic and professional leaves from just sort of leaves of absence.

The hardest thing as a program director is sort of seeing that leave of absence and being like, "What happened?" And sometimes the leave of absences are benign or actually beautiful. Like, things like, "I had a baby." Oh, great. That's wonderful, you had a baby. But all I see is leave of absence and nothing, and I'm, like, leaving it to just fill with my own anxiety.

So I do appreciate the fact that now we sort of have separated out, like, academic professional leaves of absences. I think you need to answer these head-on. I think that as an applicant, you need to say what happened, what I did to improve, what I [00:56:00] learned from it, and how I'm gonna be a better doctor because of it.

I don't recommend people be like, "Let me tell you why it wasn't my fault," or, "Why the system did me wrong." I'm like- That's, you need to just simply, this is a thing that, this is a thing that happened. Here's what I learned from it. Here's how I'm gonna be a better doctor because of it. I think you need to be able to say that, and if you can't say that, that may be something to reflect upon and think about as your journey.

It's unfortunate. Sometimes things happen, remediation happens, and I think it also depends on the severity of the thing. I think sometimes students get really nervous. Like, if you had gone to a lovely liberal arts college and then pivoted to med school where like, it's like you gotta memorize all the bones in the body, that may be a really hard pivot into med school, and there may have been some trouble in gross anatomy or microbiology.

I actually almost failed my physiology course, um, and they were like, "You may have to take summer school," and I cried, but I did pass, and I was very happy. [00:57:00] Um, but I'd gone to a liberal arts college, and the amount of memorization that I was doing my first couple years of med school was not something I was used to.

And so I would've had to have said like, "I had to re- relearn my study skills. I am a much better student for this. I got student, I got some counseling from student affairs. I'm a better student, and I am ready to take on the task of becoming a doctor and having better study skills." You just gotta say it and own it, and it might be something as like, "I had trouble pivoting."

It may be something more serious, but you gotta say what it was. I think you can't kinda dance around the issue. That, that can be the ch- that's the challenge I see sometimes in applications is they don't, they don't wanna explain, and I'm like, "Well, then I, I don't know what I'm walking into, and I'm worried."

Agreed. However, I have also seen explanations that I think go into too much graphic, salacious detail about whatever the event is that led to the extension lever gap, and so I think that applicants need to be really thoughtful about depending on what the content is, someone who reads your [00:58:00] application is just a human, and they, their brain may anchor to the details of that particular situation in a way that you do not want their brain to anchor.

So I, I would strongly, strongly recommend running this by an advisor, other trusted people in your life about- The deans ... am I, the dean, yeah. Is this a, is this a linear narrative that adequately answers the question head-on but does not give so much really personal information that is really nobody else's business, you know?

I think there is a little bit of a needle to thread there. Yes, I agree. I agree. It's, it's not, it is, this, this is all the it depends, and you need to work with an advisor about sort of here's what I'm thinking about saying. Could I frame it this way? And sometimes these are conversations that you even need to have with the dean so that everyone's kind of on the same page of like how are we, how are we supporting and, like, putting this applicant of our students out into the world.

For sure. Okay. Now I think we've exhausted most of the content regarding the ERS application and how to get an interview. [00:59:00] Let's go ahead and move into the future and talk about the interview process. So again, I tell my students what matters for getting an interview is their application, and what matters for the rank order list and matching into a program is the interview day.

So I think it's a really high pressure day, and I don't try to sugarcoat this. Do you agree with this stark advice, or do you think that's too strong? No, I mean, I think what makes or break you is your interview. M- for most programs, um, many programs are working on rubrics and some, you know, they have selection committees, and the interview day process is a heavily weighted experience because you are finally s- you, you've seen them on paper, but now you are talking to them and going, "Is this the kind of person who would thrive in our environment?

Are they gonna bring something to our community?" Like, you know, how do the residents feel about them when they're interacting in those social hours or in the lounges? What's kind of the vibe happening here? Are they, you know, are they asking meaningful questions? Are they just asking questions on the website?

So the interview day is really important, um, a [01:00:00] really, really important process, and it is high stakes, so we do encourage people to breathe To, to have fun. But it's hard and, uh, you know, I'm, I'm pretty much an extrovert, so I love interview day. Um, but I know that it can be hard for some folks. For sure. It was the

I had one interview, actually. It was at a Texas program, and it might have been the worst day of my entire life. Aw. I mean, talk about putting your foot in your mouth. So I'm not gonna tell the full story because I just can't. I simply can't bear the em- the embarrassment. No. But I will, I won't bear the lead here.

I called myself milk toast in an interview. I referred to myself as milk toast. Oh, dear. Which I, I thought meant, like, I'm a Honda Accord. Like, I'm reliable and, you know- ... I, I don't make too much of a fuss. But it means, like, weak and feeble-minded, I think is the ... And I can just- Yeah ... see the interviewer's face go.

He's just, "Huh." Huh. Eh. So, um, we have all been there. You may have one or two bad interview days. I had a day where I, um, I, I began the interview day and blanked on all the [01:01:00] questions, and I was like, "Oh, this is awful." I was like, "How am I gonna get through this?" But I did. We've been there, and it's like, "Oh, I guess I'm not gonna match here.

Good thing I have nine other interviews." Right, yes. Um, so what can applicants do to avoid this? How do you recommend applicants prepare for an interview? I think if your school has, um, opportunities to offer you mock interviews, I would recommend taking them. I think you need to practice your mock interview.

A- and I actually say this: Practice your mock interview in your full suit. Like, I know you're gonna feel like, "What?" I'm like, full suit, full lighting, all the things, all the spaces. You just need to practice it. How's the camera? How's the lighting? You don't need a really intense setup. Uh, there's a lovely article, I think it's by John Galliano, I think, um, it's in The New York Times, on, like, how to have good lighting, and it's really, like, natural light, a light behind you or above you.

Keep it simple. This is a little bit of a thing. If s- if applicants, and if ... This is telling, but it's really funny. If applicants have ring lights and the ring lights are too close, sometimes I'm kind of distracted by the [01:02:00] light in their eyes. Yeah. And I'm just like, I'm ... I feel like I'm a moth- You're an alien

I'm a moth to a flame, and I'm just like Oh, and I'm like, "Okay, wait, I gotta stop." But I'm also kind enough, like I actually had-- There was an applicant a couple years ago who's just, the room was really dark, and I actually did pause and say, "You know, your room's really dark. Do you wanna, like, change your lighting?"

And they were, like, so appreciative, and I think it was one of their first interviews, and, like, they fixed the lighting, and I was like, "Now we can see you better." And it was just really-- So I say that also to say, like, please, a- as people who are interviewing my, my fellow program directors, like, give people grace and patience, um, because it is an anxiety-provoking process.

Um, a little preparation. So having some mock interviews, you know, seeing how you do in interview processes can be really important. I think also it's important to remember not to over-prepare. You sometimes see an applicant who is just really rehearsed and really wants to tell, like, their narrative, and it's hard to kind of get them to pivot the conversation, and that feels kind of stiff and challenging there too.

So I think that can be really [01:03:00] important. Going back to the issues of AI, do not use AI during your interview. Do not record your interview. Per, um, AAMC and NRMP recommendations, programs are not recording your interview. Do not record the interview. Don't use AI during your interview. I think that could be really-- That, that can tell, and that will be really not a good look for you.

I think reading up on the program, many programs are using Thalamus or some kind of interview recording process. So you probably have the name of your interviewing faculty the night before or a couple days before, weeks before. Like, take a moment. Read up on people. It's funny 'cause I give that advice And then I'm always a little, like, surprised and shocked when someone's like, "I read your paper."

And I was like, "Oh, you did?" It never happens. It never, it really happens very rarely. I get it a couple of times and I'm like, "Oh, you read my paper?" And I'm like, "Oh, wow, you, you did? Wow." Like, okay. But just, like, read on the people. They- they've got a website page and a CV. Read about the program the night [01:04:00] before so that, like, you've read all this stuff so you're not necessarily asking the questions that are like, "How many people go to your program?"

Like, you know, but you're asking things like, "I saw you have an interventional concentration. Can I hear more about that?" Like, that says you're interested. So find ways to make sure you're showing you're interested, um, but also, like, not so overly rehearsed is something I recommend. Love it, and that's, again, a tough needle to thread because what I, one of the things that I learned on my Botch interview is I'm someone that needs to stick to a script a little bit.

That's why I outline my podcast episodes pretty extensively, because I never really know what's gonna come out of my mouth when I'm improvising. And so I think you have to know yourself well enough to know, like, if wh- what your guardrails are, or if you're someone who, when they stick to a script, they sound very scripted.

So it depends, it depends, it depends. It depends. It depends. So mock interview, if possible, with a full tech check. I think that's super big. Plug your computer into a battery, and if you need to, I- I've actually had people... I think when our, I think the internet's gotten better overall, but people were, like, putting ethernet cables in and just being like, uh...

Especially when we were [01:05:00] all really new in the pandemic, people were, like, plugging their in- ethernet cables in. Um, yeah, full tech check. Just make sure it all works. And remembering that it's a job interview, and there's a lot, a, a lot of articles out there about how to succeed in a virtual interview and what are common interview questions for a job interview.

So yes, doctors are special. We're very special, but it's still a job interview, and the same advice. Like, sometimes we think we can only have advice that's just for doctors in the Match process, but there's a lot out there on how to succeed, so don't miss that. Absolutely. And then knowing your application.

What are a few questions that you think any applicant absolutely must have, uh, an answer to, like a polished answer to? Why psychiatry? Like, uh, I mean, it, it feels really simple, but, like, why, why psychiatry? Um- Get used to it. Yeah, like, tell me, tell me, uh... Something I used to ask, and I still, still do, I try to do some variations of it, but I often say, like, "Tell me when you saw the light and knew you were gonna be a psychiatrist."

Like, they, I love say- They're like, "Yes." Um, I think that's really important. And, and a, and a caveat to that is, um, you [01:06:00] don't have to tell a negative story I didn't become an internal medicine doctor. You don't have to tell me why you're not becoming a medi- internal medicine doctor. We're good. Tell me why you wanna be a psychiatrist.

Like, like it's totally okay to just sell psychiatry to me. You don't have to go, "Well, I'm not choosing these things." I'm like, "Well, cool, neither did I." Like, but tell me why you wanna do psych. I think why psychiatry, maybe a little bit about, like, what are you thinking about as a future career in psychiatry?

It doesn't have to be, no one is holding you to this, so it doesn't have to be I'm gonna be an outpatient doc working in these five clinic areas in your hospital. Doesn't have to be that. It can just be I'm thinking about I- I've looked at outpatient medicine. I've had opportunities to be a CL psych, you know, CL psychiatrist.

I've thought about this. I think those are perfectly good to be asking about there. I think you need to know your meaningful experiences and be able to explain them to someone if they ask you, "Tell me about this meaningful experience." You're interviewing across the country, specialty clinics that look different.

Tell me how your student mental health clinic is run. Tell me how your psychiatry student interest group is [01:07:00] run. I wanna know more about that. I think that can be important as well. The only question that I would add is tell me about yourself. I think you have to go into an interview assuming that the interviewer hasn't read your application.

Hopefully, they have, and they ask you really thoughtful questions about what you've written because you worked really, really hard on it, and you deserve that as an applicant. But it doesn't always happen, and so you're gonna need to have a little three to five-minute, probably three-minute spiel on this is who I am, this is what I care about, et cetera.

Exactly. Are there any things that you think can really sink an application on or around interview day other than calling yourself milk toast or completely forgetting how to speak English on interview day? Um, being rude to the coordinators. Yeah. Uh, being rude to the coordinators, being rude to the residents.

Some folks will do an excellent job being thoughtful and professional with the faculty, and then they will let their guard down with the coordinators or the [01:08:00] residents. And we give our coordinators and residents a big say. Um, I do not want anybody in my program who was disrespectful to my coordinator.

The, uh, my coordinators are amazing and, like I would be lost without them. So I don't want anybody being disrespectful or rude to my coordinators because that to me is like, well then, you, you don't understand that like that is a piece of my arm that you're talking about, and so that's a thing there.

Think about all the people you're interacting with and being professional and respectful to everyone. You don't have to be everybody's best friend, but you need to be professional and respectful I think is really, really important. I think that's one of the big ones, um, I would say that could really potentially sink an interview is sort of not remembering it's a job interview and thinking like, "I can just say whatever."

I think also explaining if you're, if you're running late, if you're missing things, if something has gone awry. We do not expect... You know, we, we've had, we talked about the tech check, but you're interviewing for a psychiatry residency job. You're not interviewing to be an AI [01:09:00] specialist or a tech specialist in Zoom, Thalamus, Teams, et cetera.

So if there's a tech issue, let us know. You know, you should have the department's phone number to call them. You should be able to be reached in some kind of way. It's okay. Just acknowledge the tech issues. If you're unwell, programs will actually try to help with that too. Sometimes the anxiety is, "I don't wanna tell them because they're gonna think badly of me."

And I think actually what you need to do is be, just say upfront, "I'm having a challenge," so we can troubleshoot it together versus something seemed off all day and we're all like, "I don't know. I feel something off." And then later we find out, oh, they were having all these challenges. Oh, well, why didn't they just tell us?

We could help them through them better. So I think sometimes the anxiety of I don't want you to see that I'm struggling might be the challenge when it might be better to simply say, "I think I'm having a challenge with my tech." You know? Okay, well, let's think about something else. You know, we, we interview in Thalamus, but if it's a tech issue, we got Zoom, we got Teams, we can figure it out, but I can't figure it out unless [01:10:00] I know how to help you.

I think I would add, you know, if you're not going to go to one of the associated events, I think you need a pretty specific reason. I think it's a big deal, and we have, again, so few data points by which to stratify applicants that your interaction at the pre-interview, whatever it is, I think it's really important.

I think, yes, a, a, a reason is important. I just think telling us the reason. I think for me it's ghosting is the problem. Like, don't ghost. You know, 'cause sometimes the challenge is the pre-interview is also the same day as the, like, end of another interview, so, so I will give grace and patience for that 'cause I recognize it's a busy season.

I just don't wanna be ghosted. Like, that's the thing for me. I don't wanna be like they, they didn't show for this. Well, why didn't you show? Like that to me is the disrespectful part. So, so, uh, I'm okay with it, like, g- 'cause how do we define like a really good reason? You know? Like what is a really good reason?

'Cause maybe my very good reason is not the same as someone else's very good [01:11:00] reason. So I, I'm willing to give a little bit of grace and patience so long as me and the residents or the program coordinator has been informed that they're going to miss it. I'm willing to tolerate that for, for that reason.

So my take on that, for sure. Fair. And then I think seeming totally disinterested, doing no pre-reading on the program, doing no pre-reading on the interviewers, that's published in advance, I think those are things that can... Yeah, that's just-- To me, that's low-hanging fruit, and so you should be prepared in that way on interview day.

Yes, I agree. I agree. Okay. Dr. Thomas, I'm gonna ask you for final thoughts. What are your final thoughts for our audience? To those who are applying for psychiatry, I am so excited that you are choosing our field and specialty. There is so much need, and I am so excited that you are choosing this path and this process.

I want you to remember that this is the beginning, not the end. The end journey is not matching. Matching is the beginning of the journey. And so how can we help you make an excellent launch into [01:12:00] becoming an excellent future psychiatrist and colleague? And so work with your advisors. We are here to help you.

Yes, there are a lot of it depends, um, but we work together. We try to support you. We're gonna try to s- we're gonna support you. We're gonna support your colleagues. We have lovely support of each other. I'm so grateful for the Adamstep Faculty Advising Group and my colleagues, and I just wish you the best in your journey.

Well, thank you so much for coming on Psychiatry Boot Camp. I think that's a beautiful closing message. Thank you. Thank you for having me.

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Those are video episodes. Thanks again for listening. I'm your host, Mark Mullen. This episode was outlined by Amina Janjua, who is also our season producer. Our executive producers are Aron Korney, Rob Goldman, Shahnti Brooke, and me, Mark Mullen. Our editor and engineer is Jason Portizo. Our theme music was generously donated by Cave Radio.

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