- Email: [email protected]
Residency Match Interviews: Walking the Line Requires Knowing the Line
International Journal of
Radiation Oncology biology
physics
www.redjournal.org
BRIEF OPINION
Residency Match Interviews: Walking the Line Requires Knowing the Line Neha Vapiwala, MD Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Received Sep 23, 2016. Accepted for publication Sep 27, 2016.
The medical residency Match interview process is not dissimilar to that of your average job search. Interested and presumably qualified applicants whose resumes meet the proverbial “bar” are invited by prospective employers for in-person vetting. Known as “the interview,” both applicant and employer put their best (and well-dressed) feet forward, with leverage typically held by the party with greater desirability in any given situation. Whether this upper hand is held by the applicant or the employer often guides the outcome: the nature and expediency of the offer, if made, the detailed negotiations, and the eventual agreements. Here is where the job search path diverges for medical school seniors and graduates seeking employment in the form of postgraduate clinical training, a prerequisite for the intended long-term job as a board-certified practicing physician. The National Resident Matching Program (NRMP) enlists job seekers who desire access to coveted training positions at accredited and reputable institutions, and job providers who are gatekeepers to those positions. Both applicant and program commit to a binding contract, the latter agreeing to train and support the indentured. But despite this formalized program, one can argue that a medical student, no matter how desirable, does not ever truly have the upper hand. This inherent power differential is probably particularly pronounced for highly competitive specialties in which quality applicants exceed available positionsdwhich is why a code of conduct during the Match is ethically necessary, and perhaps most critical during and after the interview process. It is why the NRMP went so far as to issue a statement that “for or all Matches opening after June 30, 2016, programs are prohibited from
requesting applicants to reveal the names, specialties, geographic locations or other identifying information about programs to which they have or may apply” (1). Applicants can offer this information, but programs may not inquire. Reported violations of these terms could lead to investigation. If wrongdoing is confirmed, sanctions of termlimited or permanent bans from Match participation are imposed, and literally everyone from the hospital chief executive officer to the Accreditation Council for Graduate Medical Education is notified. Despite the threat of this stick and despite the recent publications highlighting the need to strive for Match process-related integrity in radiation oncology (2, 3), the survey by Berriochoa et al. indicates that we clearly still have work to do given the frequency of potential Match violations reported (4). The majority of offenses seemed to involve inappropriate interview questions, albeit at a minority of interviews. Dismissing or minimizing concern over the bad behavior of a relative few, however, does not negate the deleterious impact upon the applicants’ experiences, the program’s compliance with NRMP policy, or our specialty’s reputation. It is not clear why this is occurring among academic radiation oncology interviewers. Inexperience? Generation gap? Disregard? Rest assured, our specialty is not a lone culprit. Hern et al (5) surveyed all residency applicants to all specialties to characterize the prevalence and impact of potentially illegal questions during the residency interview process in 2012 to 2013. With a response rate of 51.1% (10,976 of 21,457 eligible applicants), 65.9% of respondents reported receiving at least 1 potentially illegal question, and 15.5% were asked about
Reprint requests to: Neha Vapiwala, MD, Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of
Pennsylvania, 3400 Civic Center Boulevard, TRC 2, West Philadelphia, PA 19104. Tel: (215) 662-7266; E-mail: [email protected]
Int J Radiation Oncol Biol Phys, Vol. 97, No. 1, pp. 9e10, 2017 0360-3016/$ - see front matter Ó 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ijrobp.2016.09.039
10
Vapiwala
applicant commitment to a program. Questions about gender, marital status, or plans for having children were more likely to be posed to female than male respondents (P<.001). Not surprisingly, the potentially illegal questions negatively affected how respondents perceived and ranked those programs. Rather than accepting these risks that inappropriate interview and postinterview communication can pose, let us strive to do better. Interviewer training before every Match season could help to address these issues. Open discussion of NRMP policies to establish expectations, increase awareness, and promote compliance can lead to small but real cultural change over time. Those who conduct interviews for any professional position are likely aware that questions intended to reveal age, race, national origin, gender, religion, marital status, and sexual orientation are off-limits, unless they directly relate to specific qualifications for the job. Even then, the inquiry intent needs to be clear. State and federal laws prohibit discrimination based on certain protected categories, such as national origin, citizenship, age, marital status, disabilities, arrest and conviction record, military discharge status, race, gender, or pregnancy status. Perhaps because the Match is not typically viewed as a process encompassed within the realm of employment law, we find ourselves inadvertently or purposefully breaking it. Perhaps we need to add “medical
International Journal of Radiation Oncology Biology Physics
trainee” to this protected list. It is tough enough for applicants to audition for a specialty this competitive; fielding inappropriate questions and dodging coercive conversations should not be par for the course.
References 1. National Resident Matching Program. Press release: NRMP board of directors revises policy to ensure an equitable Match process. Available at: www.nrmp.org/press-release-nrmp-board-of-directors-revises -policy-to-ensure-an-equitable-match-process/. Accessed September 20, 2016. 2. Holliday EB, Thomas CR Jr., Kusano AS. Integrity of the National Resident Matching Program for radiation oncology: National survey of applicant experiences. Int J Radiat Oncol Biol Phys 2015;92:525531. 3. Wu AJ, Vapiwala N, Chmura SJ, et al. Taking “the game” out of the Match: A simple proposal. Int J Radiat Oncol Biol Phys 2015;93:945948. 4. Berriochoa C, Ward MC, Weller MA, et al. Applicant interview experiences and postinterview communication of the 2016 radiation oncology match cycle. Int J Radiat Oncol Biol Phys 2016;96:514-520. http://dx.doi.org/10.1016/j.ijrobp.2016.08.009. 5. Hern HG, Trivedi T, Alter HJ, et al. How prevalent are potentially illegal questions during residency interviews? A follow-up study of applicants to all specialties in the National Resident Matching Program. Acad Med 2016;91:1546-1553.
Radiation Oncology biology
physics
www.redjournal.org
BRIEF OPINION
Residency Match Interviews: Walking the Line Requires Knowing the Line Neha Vapiwala, MD Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Received Sep 23, 2016. Accepted for publication Sep 27, 2016.
The medical residency Match interview process is not dissimilar to that of your average job search. Interested and presumably qualified applicants whose resumes meet the proverbial “bar” are invited by prospective employers for in-person vetting. Known as “the interview,” both applicant and employer put their best (and well-dressed) feet forward, with leverage typically held by the party with greater desirability in any given situation. Whether this upper hand is held by the applicant or the employer often guides the outcome: the nature and expediency of the offer, if made, the detailed negotiations, and the eventual agreements. Here is where the job search path diverges for medical school seniors and graduates seeking employment in the form of postgraduate clinical training, a prerequisite for the intended long-term job as a board-certified practicing physician. The National Resident Matching Program (NRMP) enlists job seekers who desire access to coveted training positions at accredited and reputable institutions, and job providers who are gatekeepers to those positions. Both applicant and program commit to a binding contract, the latter agreeing to train and support the indentured. But despite this formalized program, one can argue that a medical student, no matter how desirable, does not ever truly have the upper hand. This inherent power differential is probably particularly pronounced for highly competitive specialties in which quality applicants exceed available positionsdwhich is why a code of conduct during the Match is ethically necessary, and perhaps most critical during and after the interview process. It is why the NRMP went so far as to issue a statement that “for or all Matches opening after June 30, 2016, programs are prohibited from
requesting applicants to reveal the names, specialties, geographic locations or other identifying information about programs to which they have or may apply” (1). Applicants can offer this information, but programs may not inquire. Reported violations of these terms could lead to investigation. If wrongdoing is confirmed, sanctions of termlimited or permanent bans from Match participation are imposed, and literally everyone from the hospital chief executive officer to the Accreditation Council for Graduate Medical Education is notified. Despite the threat of this stick and despite the recent publications highlighting the need to strive for Match process-related integrity in radiation oncology (2, 3), the survey by Berriochoa et al. indicates that we clearly still have work to do given the frequency of potential Match violations reported (4). The majority of offenses seemed to involve inappropriate interview questions, albeit at a minority of interviews. Dismissing or minimizing concern over the bad behavior of a relative few, however, does not negate the deleterious impact upon the applicants’ experiences, the program’s compliance with NRMP policy, or our specialty’s reputation. It is not clear why this is occurring among academic radiation oncology interviewers. Inexperience? Generation gap? Disregard? Rest assured, our specialty is not a lone culprit. Hern et al (5) surveyed all residency applicants to all specialties to characterize the prevalence and impact of potentially illegal questions during the residency interview process in 2012 to 2013. With a response rate of 51.1% (10,976 of 21,457 eligible applicants), 65.9% of respondents reported receiving at least 1 potentially illegal question, and 15.5% were asked about
Reprint requests to: Neha Vapiwala, MD, Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of
Pennsylvania, 3400 Civic Center Boulevard, TRC 2, West Philadelphia, PA 19104. Tel: (215) 662-7266; E-mail: [email protected]
Int J Radiation Oncol Biol Phys, Vol. 97, No. 1, pp. 9e10, 2017 0360-3016/$ - see front matter Ó 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ijrobp.2016.09.039
10
Vapiwala
applicant commitment to a program. Questions about gender, marital status, or plans for having children were more likely to be posed to female than male respondents (P<.001). Not surprisingly, the potentially illegal questions negatively affected how respondents perceived and ranked those programs. Rather than accepting these risks that inappropriate interview and postinterview communication can pose, let us strive to do better. Interviewer training before every Match season could help to address these issues. Open discussion of NRMP policies to establish expectations, increase awareness, and promote compliance can lead to small but real cultural change over time. Those who conduct interviews for any professional position are likely aware that questions intended to reveal age, race, national origin, gender, religion, marital status, and sexual orientation are off-limits, unless they directly relate to specific qualifications for the job. Even then, the inquiry intent needs to be clear. State and federal laws prohibit discrimination based on certain protected categories, such as national origin, citizenship, age, marital status, disabilities, arrest and conviction record, military discharge status, race, gender, or pregnancy status. Perhaps because the Match is not typically viewed as a process encompassed within the realm of employment law, we find ourselves inadvertently or purposefully breaking it. Perhaps we need to add “medical
International Journal of Radiation Oncology Biology Physics
trainee” to this protected list. It is tough enough for applicants to audition for a specialty this competitive; fielding inappropriate questions and dodging coercive conversations should not be par for the course.
References 1. National Resident Matching Program. Press release: NRMP board of directors revises policy to ensure an equitable Match process. Available at: www.nrmp.org/press-release-nrmp-board-of-directors-revises -policy-to-ensure-an-equitable-match-process/. Accessed September 20, 2016. 2. Holliday EB, Thomas CR Jr., Kusano AS. Integrity of the National Resident Matching Program for radiation oncology: National survey of applicant experiences. Int J Radiat Oncol Biol Phys 2015;92:525531. 3. Wu AJ, Vapiwala N, Chmura SJ, et al. Taking “the game” out of the Match: A simple proposal. Int J Radiat Oncol Biol Phys 2015;93:945948. 4. Berriochoa C, Ward MC, Weller MA, et al. Applicant interview experiences and postinterview communication of the 2016 radiation oncology match cycle. Int J Radiat Oncol Biol Phys 2016;96:514-520. http://dx.doi.org/10.1016/j.ijrobp.2016.08.009. 5. Hern HG, Trivedi T, Alter HJ, et al. How prevalent are potentially illegal questions during residency interviews? A follow-up study of applicants to all specialties in the National Resident Matching Program. Acad Med 2016;91:1546-1553.