Comprehensive Interview Prep Material

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Comprehensive Interview Prep Material Note: Friends the below material is from FB USMLE 2012 forum. Work of many US residency aspirants. I just compiled them for you all (All TN Medical Colleges USMLE aspirants). I tried my best, in my limited time, to make it reader friendly. Plz make it better and pass it on to future aspirants. Feel free to update with ur experience.

Always have this thing at ur face "SMILE" Honour – Time, Place and Person Interviewing When should I interview? Most students block out several weeks sometime between November and February for interviewing. How important is the interview? Once you have been offered an interview, you can pat yourself on the back because the program considers you a competitive candidate for their residency program. Realize, however, that your work is not done. Surveys of residency program program directors have have revealed that the interview is the most most important criterion used in the selection of residents. So do not take the interview lightly because a poor interview will seriously damage the candidacy of even the most qualified applicant while an outstanding interview can significantly strengthen your application. How much time off should I take to interview? The amount of time time you need to interview varies depending upon the number of residency residency programs you are applying to. Other factors such as the location of the residency programs also plays a role. For example, if you are not restricting restricting yourself to a certain region of the country, country, you may be travelling to all parts (East coast, coast, West Coast). Coast). You will have have to factor factor this in. Do programs wait to schedule interviews until all application materials are received? This varies from residency program to residency program. Many programs will not offer interviews until all components components of the application application have been received while others others will begin scheduling scheduling interviews even before they have received some some parts of your application application such as the Dean's Dean's letter. Since it is difficult to know how the residency programs you are interested in operate, it's in your best interests to stay on top of your application. application. On what days do programs interview? Again, this varies from program to program. Some programs have set aside several days out of every week for the entire interview season to interview applicants while others only offer interview dates once or twice a month. month. When you are offered an interview, try to accept one of the dates that has been given to you. Try not to make any special requests such as setting up an interview on a day when the program is not planning to interview applicants. The program may view this negatively. Where should I interview first?

Even before interviewing, you you will have some thoughts as to which programs are more more or less less desirable. Schedule your early interviews at less desirable programs. This will allow you to ease yourself into the interview process. As your confidence grows with experience, you will place yourself in a position to shine in your later interviews. i nterviews. How should I prepare for the interview? Preparation is the key to interviewing interviewing well. Try to anticipate anticipate questions you may may be asked so that you can give some thought as to how you will answer them. Questions that interviewers commonly ask interviewees include the following: Why did you choose choose this specialty for your your career? What What do you like most most about this specialty? specialty? What do you like least about this specialty? Why did you apply to this residency program? What are you looking for in a residency program? Where do you see yourself in five years? Ten years? years? What are your greatest greatest strengths? What are your greatest weaknesses? A very useful way to prepare for the interview is to participate in a mock mock interview. Many medical medical schools offer mock mock interviews. If your school does does not, ask your advisor if he or she would be willing to play the role of an interviewer. When should I arrive for my interviews? Make every effort to arrive in your interview interview city on the day before the interview, preferably in the morning or afternoon. afternoon. Arriving early will of offer fer you some flexibility should something something unforeseen occur (e.g., (e.g., bad weather). weather). You will also have a chance chance to to visit the institution institution so that you can can familiarize yourself yourself with where you need to go go to start your interview day. day. Also keep in mind that some programs invite applicants applicants to an informal informal dinner dinner on the evening evening before the interview day. day. You certainly don't don't want to miss this opportunity opportunity to meet meet faculty and house house staff. Should I ask the interviewer questions? At some point in the interview, interview, your interviewer interviewer is likely to ask you if you have have any should never never answer "no" because because this is essentially saying saying that you have no interest in the program, program, which may may or may may not be true. Prepare questions beforehand but make make sure that the questions questions you you ask are appropriate. Questions about vacation, call schedules, and benefits are appropriate questions for house officers but will not put you in the best possible light with faculty. Questions that you may wish to ask fa faculty culty include the following: What didactics are are offered by the department? department? Do the residents have

protected time so so that they can attend the didactic didactic sessions? sessions? What What

percentage of the residents go on to pursue fellowship training? How have the residents performed on the specialty board certification certification examination? examination?

Even before interviewing, you you will have some thoughts as to which programs are more more or less less desirable. Schedule your early interviews at less desirable programs. This will allow you to ease yourself into the interview process. As your confidence grows with experience, you will place yourself in a position to shine in your later interviews. i nterviews. How should I prepare for the interview? Preparation is the key to interviewing interviewing well. Try to anticipate anticipate questions you may may be asked so that you can give some thought as to how you will answer them. Questions that interviewers commonly ask interviewees include the following: Why did you choose choose this specialty for your your career? What What do you like most most about this specialty? specialty? What do you like least about this specialty? Why did you apply to this residency program? What are you looking for in a residency program? Where do you see yourself in five years? Ten years? years? What are your greatest greatest strengths? What are your greatest weaknesses? A very useful way to prepare for the interview is to participate in a mock mock interview. Many medical medical schools offer mock mock interviews. If your school does does not, ask your advisor if he or she would be willing to play the role of an interviewer. When should I arrive for my interviews? Make every effort to arrive in your interview interview city on the day before the interview, preferably in the morning or afternoon. afternoon. Arriving early will of offer fer you some flexibility should something something unforeseen occur (e.g., (e.g., bad weather). weather). You will also have a chance chance to to visit the institution institution so that you can can familiarize yourself yourself with where you need to go go to start your interview day. day. Also keep in mind that some programs invite applicants applicants to an informal informal dinner dinner on the evening evening before the interview day. day. You certainly don't don't want to miss this opportunity opportunity to meet meet faculty and house house staff. Should I ask the interviewer questions? At some point in the interview, interview, your interviewer interviewer is likely to ask you if you have have any should never never answer "no" because because this is essentially saying saying that you have no interest in the program, program, which may may or may may not be true. Prepare questions beforehand but make make sure that the questions questions you you ask are appropriate. Questions about vacation, call schedules, and benefits are appropriate questions for house officers but will not put you in the best possible light with faculty. Questions that you may wish to ask fa faculty culty include the following: What didactics are are offered by the department? department? Do the residents have

protected time so so that they can attend the didactic didactic sessions? sessions? What What

percentage of the residents go on to pursue fellowship training? How have the residents performed on the specialty board certification certification examination? examination?

Do you anticipate any changes in the residency program over the next few years? If so, what changes? Does Does the residency program program assist assist residents in finding jobs after residency? When should I send thank-you notes? notes? Thank-you notes or letters letters should be sent to each of your interviewers as as well as the residency program director. They should should be sent within 72 hours of your interview. In your letter, be sure to thank them for the opportunity opportunity to interview interview at their program. program. Don't forget to thank them for any food or lodging assistance assistance they provided. provided. Some questions questions and some sample answers answers i have found.. (not very well sorted and lots of repeated questions questions but i guess you guys guys can make make out). .dont use them exactly as lots of people read the same samples.. .. It also contains many many people's personal experiences posted online Any interesting patients that you might might have have seen? Why did you choose choose Internal medicine, or or FM, PSY, Or Pathology as a career? Tell me about your your weaknesses? Tell me about your strengths? Tell me about one thing you could change about yourself? why you choose choose this program? program?

Although above mentioned questions are the core core questions but interview starts with something something like this...(from what i have heard) heard) -did you have have any trouble getting here? or any trouble trouble finding this place? -how do you like weather here? -was there any traffic on your way here? -how do you like this city? Although they they r not that important, if they r answered well well it can set positive tone for rest of the interview. You dont have to whine or complain about about anything like "i dont like the weather here" or or "it was troublesome for me to get here" Even answer to "So, how are you feeling today?" should be like this "i am feeling great" or "i am excited to be here". Dont whine like "i am feeling feeling tired" or just reply "OK" Tell me about yourself?

I would start by telliing them about your education background and your current employment or past employment and discuss positive and strong points of your work.... .during this conversation you need to show the interviewer the positive and strong background of your character., work hard , motivated, can work alone or with other, good communication skill with some example to reinforce those statements. ...for example, working directlly with physician and medical professional or you can say i was part of a team or team leader or committee to evaluate turn around time for ER admissions or part of CQI where we implement some guidelines and recommendation to evaluate for the next few weeks.. ... you need to address that these characters what you will bring to the program.. ... etcc.. .. What are you looking for in a training program? I am looking for a program that has a healthy balance of hands-on training and didactic curriculum. Specifically a program that

values teaching. In addition I would like to join a program that

encourages research endeavors while valuing close communication with residents and attendings. Patient diversity and good exposure to ambulatory care is also important A friend suggested to me and worked perfectly: Call to PC like a few weeks before the interview date to ask your IV itinerary. They will disclose it readily. Not only you get the correct spelling of the names of the people you will meet but also you will have time to study research, clinical and educational interests of those people. Another example What is your greatest strength?

•My ability to work with all different kinds of people. I enjoy learning from everyone I meet. •My greatest strengt h is my ability to focus on the job at hand. I'm not easily distracted from the big picture.

•My organizational skills are my greatest strength. I'm capable of keeping many projects on track at the same time. I believe that my greatest strengths are 100% commitment to whatever I do and my problem solving skills. I am capable of communicating effectively at all levels of the organization. My greatest strength is that I never give up when there are obstacles in my life... I always look for self confidence, motivation and ability to work as an individual and in a group. How do you handle conflict? Answer: I am a very friendly and easy going person and I normally do not get into conflicts with my co-workers. But in case if a conflict do arise, I would first examine if my behavior or action might have potentially contributed to the conflict. If that i so I would rectify myself and apologize to the person concerned. In case if the conflict i due to the other persons behavior, then I would try to resolve it in a friendly, open manner by explaining to him or her about the issue and asking suggestions how to avoid similar issues in the future. If we couldn't do it ourselves, I would seek the advice of my mentor for possible mediation.

Do you have any question for me? this is when the PD or who ever you interviewing ask you if you have any question about this program

Answer : I went through the program website and also had discussion with the residents here. I was able to get all the info that I needed. I do have one question.

Could you describe how the residents are evaluated during the residency training? Is there a periodic evaluation of the performance? Will I be having a mentor to advise me during my training? What are your strengths? Answer: I am a hard worker. I am very focused on my goals. I persevere during difficult times. I am also analytical, thinking about all aspects of a given situation before making a decision. All these strengths have helped me so far in life. The fact that I am considered in this reputed program even though I am a FMG is a testimony to my strengths. I am very confident these qualities will help me in future is becoming an excellent doctor. What are your future Plans? How do you want to look yourself in 10 years time? Briefly explain an interesting case you have managed in your career? Why did you choose our program to apply? Why should we choose you as a resident in our program? What is your experience in research? If present explain briefly. What is your greatest strength? A few good examples: Your ability to prioritize, Your problem-solving skills, Your ability to work under pressure, Your ability to focus on projects, Your professional expertise, Your leadership skills, Your positive attitude Give some example of those positive aspect or situation . Sb asked me for the list of interview questions. i have tried to incorporate every possible questions you might face. some are more high yield than others. If you want to discuss any question, we can discuss here. 1. How much do you know about our program 2. Tell me about yourself? 3. What motivates you? 4. Which three adjectives best describe you? 5. What are Your qualities you are proud of? 6. What are your strength and weaknesses?

7. How well do you take criticism. 8. If you could change one thing about your personality, what would it be? 9. What differences do you see in the health care system between your and this country? 10. What do you think are the draw backs in medical system in USA from your perspective"? 11. Why did you choose to be a physician 12. What are the three achievements or qualities that you are proud of? 13. What do you think are the most important traits in a clinician 14. Why do you want to go into this speciality? Why did you choose internal medicine? 15. In what subspeciality would you like to go.? 16. Why did you apply to this program. ? 17. What do you think you will contribute to our speciality/ program 18. Present an interesting case. 19. What errors have you made in your patient care. 20. What was the most memorable experience in your school. 21. How would you change the health care delivery system of the country? 22. What is the biggest challenge facing health care delivery? 23. How do you see the delivery of health care evolving in the 21st century. 24. Tell me about the patient from whom you learned the most 25. What do you think of hospitals that refuse admission to patients without insurance?? 26. How well do you see yourself adapting to the American Health System? 27. What do you consider the positive and negative aspects of this specialty? 28. What are your expectations regarding this program? 29. How do you see the health care delivery system of the country evolving? 30. How have you changed since high school? 31. What are the major deficiencies in your medical school training? How do you plan to get over those? 32. What medical school course or class interested you the most. 33. What problems will our speciality face in the next 10 years?

34. What sacrifice are you willing to make to become a specialist 35. Where do you see yourself in ten years from now? As an academician or as a community physician?? 36. How do you think socialized healthcare will affect medical progress? 37. How will you as a physician try to curb the rising cost of health care ? 38. What has shaped you the most and got you where you are at today 39. What was the most difficult and trying time in your life. How did you handle it? 40. What was the most important event in your life 41. How do you think you can be a productive member of our residency program?

42. Why America and not your own country? Don’t your countrymen need good doctors? 43. How does your roommate describe you? 44. If you could be any cell in the human body, which would it be? 45. What is more imp, knowledge or imagination. 46. You are organized and structured or flexible? 47. Are you serious and dedicated or relaxed? 48. If your house was burning, what are the three objects you would save ? 49. What are your three wishes? If you have unlimited money, what would you do. 50. What is the most important thing in your life. 51. If you are deserted on an island, what would you take with you? 52. What kind of people do you get along with? 53. Describe your best friend. 54. Who are your heroes 55. What is the last book you read? a. The God Delusion by Richard Dawkins 56. How do you define success 57. f you could accomplish only one thing in your life, what would it be? 58. What physician characteristics do you admire the most? 59. In your med school, whose work do you admire the most and why

60. What do you do in your spare time. , if you had a free day, what would you do? 61. Have you done any volunteer work 62. What is the most bizarre thing you have ever done 63. Where have you travelled. 64. What nonmedical magazines do you regularly read 65. What would you do if you found out one of your colleague is using drugs/ alcohol? 66. In which situation are you most efficient? 67. To which organization do you belong? 68. Would you have any trouble working in this predominantly catholic hospital How important is family for you? 69. If you could no longer be a physician, what career would you choose? 70. Biggest failures in life and what have you done to ensure that they won’t happen again? 71. How will you incorporate your research interest into your residency and future career? 72. How do you make decisions. Are you a risk taker? 73. What was the most difficult decision you had to take in your life. 74. What motivates you to study?

75. What have been the biggest failures in your life? What have you done to ensure they don’t happen again 76. Which type of people do you have trouble working with. 77. Describe the worst attending you ever worked with 78. What kind of patient do you have trouble dealing with. 79. How do you normally handle conflict? How do you handle disagreements with colleagues or attending. 80. How do you handle criticism. 81. What subject or rotation did you have the most difficulty. 82. What has been your greatest challenge 83. How much of lifestyle considerations fit into your choice 84. What qualities are you looking for in a program? 85. What will be the toughest aspect of this speciality for you ?

86. can you stand for a long time. Are you willing to do graveyard shifts and all weekends for a month. ?? 87. Why should we take you in preference to other candidates? What makes you unique 88. What Is your energy level like? 89. How well do you function under pressure. 90. How well do you handle death? 91. What is managed care? copayment.

HMOs? PPOs? Capitation? Prepaid medical system? Deductible,

92. What does a cross cultural approach to healing mean? 93. What recent newsworthy medical event would you like to discuss? 94. What do you think is the no 1 issue facing our specialty now? 95. If a patient just stabbed your best friend, what would you do? 96. What would you do if the housestaff have a job action, aka a strike? 97. Should physicians be involved in active euthanasia? 98. What do you think about using animals in medical research and teaching 99. Is health care rationing ethical? 100. What would u do if a colleague wanted to keep a therapeutic error secret from the patient? 101. What clinical experience have you had in this specialty? 102. Why is medicine called an art, or a practice? 103. What do you think of physician advertising. 104. Why are beer cans tapered at the top and the bottom? 105. Why are manhole covers round and not square? 106. How do you weigh a jet plane without dismembering it? 107. Tell me a joke. 108. Where else have you interviewed? 109. What is your stand on abortion and cloning?

110. What if you don’t match? 111. What errors have you made in patient care? Sample answer

112. What is the greatest fear about practicing medicine? 113. Anything else you would like to add? 114. If you were offered a position today, would you accept? 115. What would you do after your residency? Will you go back to your country? 116. Tell me one important research article you have read recently in a medical journal. SHOULD PHYSICIANS BE INVOLVED IN ACTIVE EUTHANASIA ?? a. Well there are different types of euthanasia: active, passive, assisted suicide and voluntary refusal of food and fluids. Passive euthanasia, ie withholding treatment for patients who have a gleam hope of recovery, including persistent vegetative state, is already practiced everywhere. Voluntary refusal of food and fluids (VRFF) or Patient Refusal of Nutrition and Hydration (PRNH) is practiced in states prohibiting active euthanasia. b. Some forms of euthanasia, like assisted suicide( but not active euthanasia) are legal in Oregon and Washington, and europian countries like Luxemburg, Belgium, Netherland, Switzerland and also Thailand. I saw a documentary of a very pathetic story of a man with ALS who had to be moved from London to Netherland just for euthanasia. It was a very moving sight for me. c. When it comes to active euthanasia, its very controversial. Every patient has a right to his own body and what he wants to do with it, so if a person with MND and no hope to recover any function decides to die, mightbe we should respect his decision. Or a person or locked in syndrome, or painful and terminal cancer. But on the other hand, assisting in suicide does sound very unethical. I guess the best way out is to define some criteria to fulfill before the patient is approved for euthanasia, so that it is not indiscriminately overused. IS HEALTHCARE RATIONING ETHICAL ? It depends on what basis the rationing is being done. Health care rationing according to necessity, with sicker people getting better treatment, what we call triage, and less sick people getting less intense treatment, is plausible. While on the other hand if health care rationing occurs according to the patient’s ability to pay, or race, then it is definitely unethical. For example, studies have shown that physicians preferentially treat white population better than black, with more investigations, and more use of drugs. This is unethical. Also people who cannot pay and are treated in the state funded safety net hospitals get less investigations and less intense treatment, which is unethical. Having said that, certain procedures for cosmetic purpose , or treatments in trial which havent yet been proved effective, and are very expensive, might well be rationed for those who can pay, so as not to overburden the system WHAT DO YOU THINK OF PHYSICIAN ADVERTISING ?

On one hand, advertising increases the patient’s awareness about the treatment optio ns available, while on the other, physician advertising is a conflict of interest on the part of physician. He is trying to do the best for the patient, but is also enticing patients to come to him, when that might not be the best option. Also US is the only country where controlled drugs are advertised on national media. I was amazed to see advertisements for drugs like aripiprazole and ropinirole on

local and national television channels, and daily newspapers. Pharmaceutical companies are trying to make a dirty profit by brainwashing the minds of common people, who will think they have the disease and need that medication. It really makes the work of the physician very hard too,

explaining why they don’t need the treatment that is being advertised. In fact they say the condition called restless leg syndrome is invented by the pharmaceutical industry to sell their

ropinirole and pramipexole. Its ridiculous seeing adds that say ‘Are your legs restless at night? Then you might have

restless leg syndrome. Go see your physician now, and ask him for

ropinirole.’ I have never seen pharmaceuticals as profit oriented as over here. WHAT ARE YOUR VIEWS ON ABORTION AND CLONING ? a. Well abortion can be for medical reason, or as a personal choice. All agree that abortion for a medical reason is not to be questioned. As for abortion as a personal choice, there is no easy answer. On one hand a woman should have complete authority over her body and what to do with it, and should be able to discontinue her pregnancy if she so wishes, on the other hand terminating a perfectly viable and normal pregnancy sounds unethical. There’s no easy answer. Still I think the mother should be given complete authority to make the decision about her fetus. b. There are different kinds of cloning. Therapeutic cloning in stem cell research by way of somatic cell nucleus transfer (SCNT) is well accepted, and shouldn’t be opposed by anybody, as stem cell research holds great promise in treating diseases as far and wide as DM to MS to phenylketonuria. Reproductive cloning, on the other hand, is again successfully done for sheep to camel to abradors and particular breeds of horse, and I don’t see any reason to object on that. Cloning extinct and endangered species might be a good idea too. But cloning human beings is probably too dangerous, as it raises a question on the genetic identity of the individual itself. Its like the nightmare envisioned in Aldous Huxleyâ €™s Brave New world. WHY IS MEDICINE CALLED AN ART, AND A PRACTICE ?? a. Medicine is a science, but there is more to it than that. Unlike other sciences, where the subject under study always behave the same under similar circumstances, humans don’t. Patients with same disease can have such different presentation and natural course of illness that nothing can be predicted in medicine. A single presentation can be a result of many diseases, and vice versa. So the clinical judgement of a physician is very important. No matter how sound our knowledge are,

humans cant be tested in a lab, or be expected to operate along certain principles. That’s why it needs a human to fix a human, and that’s why medicine is  an art rather than science. Physicians practice this art, that’s why it’s a practice. WHAT QUALITIES ARE YOU LOOKING FOR IN A PROGRAM ?

a. Good teaching learning activity and moderate workload (don’t say this in BarnabasïŠ) b. Moderate level of stress, helpful ancillary staff, close contact and supervision from the attending, ie supervised autonomy. c. opportunity for direct patient care, supervised autonomy, self directed learning and friendly working atmosphere

MOTHER OF ALL QUESTION: TELL ME ABOUT YOURSELF Well, I am a medical graduate from xxxxxx, a country in Asia. I graduated in 2008. Before graduation, I completed one year of compulsory rotatory internship in different departments of our hospital., including 3 months in internal medicine. During that period, I used to see patients independently in the outpatient clinic and the emergency room, admit patients under the supervision of seniors and take care of them in the floor, and perform different procedures like lumbar puncture and pleurocentesis under guidance from my seniors. I am a real hardworking and self motivated kind of person. ii. I am also very efficient when working in a team. I worked as a team leader in a 3 month long residential outposting in a remote area of our country that we had to complete as a part of our public health curriculum. It was a good learning experience for me on how to work as a team. iii. After graduation, I worked as a teaching assistant in a reputed medical university in xxxxxxx for one year. I used to teach pathophysiology to the undergraduate students. There I got to interact with people from different cultural backgrounds, from middle east to asia to Africa. It made me culturally competent- I can get along with people from different kind of cultures. I also developed deep interest in the teaching profession. iv. After that, I prepared for my USMLE steps, and passed with good marks. After coming here, I worked as a volunteer in the Internal medicine department of xxxxxxxxxxxxxxxxxx for one and a half month. It helped me familiarize myself with the healthcare delivery system of the States, including doctor patient relationship, patient privileges, informed consent, effective communication skills as well as giving me a glimpse of what residency in US would be like. I participated both in the outpatient clinic and the different activities in the floor including conferences and teaching learning sessions. I saw how the residents and the interns handle stress in a busy environment, which was quite inspiring. I think my experience over there will definitely help me work more efficiently as an intern in your program. v. I have also co-authored a couple of books on medicine, and I was granted a research fund for an independent research proposal I submitted to the health research council of our country. c. Considering all these, I think I can really be a good candidate for your program. I can bring all that experience to your program. If you would consider me capable enough for your program, then I will try to meet your expectations to the best of my ability. d. Dedicated, thorough and hard working, (perfectionist, intelligent), can handle criticism well. WHAT ARE YOUR STRENGTH AND WEAKNESSES ? Strength: I am a hardworking and self motivated kind of person. I used to take care of patients independently in the OPD and ER of our hospitals. I am also very efficient when working in a team. I used to take care of patients under the supervision of my seniors in the floor of my hospital. I have also worked as a group leader in 2 research projects. I have a good grasp of pathophysiology of diseases, and the multisystem effects each disease can have.

Teaching pathology in a reputed university of xxxxxxxx for one year really strenghthened my knowledge of pathophysiology. I have also worked with people from different cultural background, which has made me culturally competent. b. Weakness: I cant stand people being shabby in their work. I try to do the best I can in any job, and I expect the same from others, so I really cant tolerate people who are casual, tho they might bring out the same results as me. (its better to avoid this hackneyed answer)

c. I used to be very critical of others. I can handle other people’s criticism, but I am also critical of people who are shabby and casual in their work, esp if we are on the same team.Probably that was because I always tried to judge people my way. But I have learnt to do better- I have learnt to be tolerant, to give people space, let them be. Afterall everybody has their own strong points and weak points.

d. I used to be very intolerant with patients who don’t comply with the treatment. But lately I have realized that there is always a reason behind their noncompliance, and that it is as much my responsibility to ensure compliance as is theirs, perhaps even more on my part. e. I have to finish all my work before I take a rest. I cant relax with jobs pending, but I guess I will have to develop that habit. WHAT IS SOCIALISED MEDICINE ? Keeping it short, Socialized Medicine is government-funded health coverage, with the funds derived mostly from taxes and all people have financial access to the doctors and health services. Examples of such systems are UK The Health system in the United States has been a combination of social and capitalistic elements. Medicare and Medicaid form the socialistic component - while Employer-provided health insurance coverage and self-paid coverage forms the capitalistic element, if you will, since it depends on people's ability to pay. Medicare coverage starts for citizens only after age 65 - while Medicaid covers the poor and qualifying children. And for the rest of the people, if the employer does not cover health insurance, people need to pay out of their own pockets - which is not affordable to many. As of 2007, America has about 47 Million people that

are uninsured, either due to unaffordability or by choice.

Employers are slowly starting to drop coverages too - you will begin to understand why when you read about how General Motors lamented that it spends about $1525 on health insurance per vehicle produced in comparison to $201 that Japanese Toyota does. Phew ! and its another story than Japan tops the list of the most long-lived people. 1. Get bankrupt when a medical condition wipes out all savings (Medical bills can mount to $200, 000 in heart surgeries!) 2. Do not see physicians for problems at all, allow problems to reach a complexity that's more expensive to treat.

3. Use unproven, risky off-the-shelf cheaper alternative medicines 4. Fly overseas to India, Thailand - i.e.medical tourism 5. or worse - simply pile up on Emergency centres of hospitals to take unfair advantage of the EMTALA act, which says hospitals are required to cover basic treatment for any person wanting care, irrespective of their ability to pay 6. As the number of uninsured increase, the insured Americans have to pay a greater premium to generate the big pot of insurance money. "The healthy discount the sick" A huge section of the American population now believes a lot of these problems can be solved if health insurance coverage was made compulsary, private health insurance was dissolved and the government covered everyone through taxes, which will bring down premium rates and and make health care cheaper. [As of 2007, America speands more than 18% of GDP of Health care !!] But given the shocking profits that private health insurance plans make and the 10-20 Million Dollar salaries that insurance CEOs make, it's gonna be tough to break their heavily-funded political lobby and replace them by a socialistic model. Hope this gives all of you guys enough food for thought and good arguments to put forth, when asked that question on the residency interviews :-) WHAT WOULD YOU DO IF YOU FIND YOUR FRIEND IS USING DRUGS/ALCOHOL If a colleague is concerned that a physician has an SUD, AKA substance use disorder that is impairing his or her functioning, it is that colleague’s ethical duty to act immediately to intervene. The best approach is usually to contact a Physicians Health Program (PHP), rather than the state medical board, and to report the suspected addicted physician. " So How about first Confronting and confirming from the Physician himself before taking it to the authorities? "Contacting a PHP can be done anonymously and is usually better than trying to confront the individual directly since most addicted physicians have high levels of denial and are usually not receptive to interventions from colleagues."Hmmm.. Note that PHP does not punish the physician, rather works with the physician to resolve the issue while allowing the physician to keep practice license. Punitive actions, license revoking, etc. after reporting the physician to the State Medical Board were the old days, the new ideology is to treat the physician for his ailment rather than punish him/her for it. Why not ? When addicted, the person is unable to control him/herself to abstain from it ..and that exactly is the ailment - and punish for a disease ? Interestingly, the highest incidences of Substance abuse amongst physicians are seen amongst the Anesthesiologists and Emergency Medicine Since many IMGs wrote about being asked this question on the Residency interviews in primary care specialties Family Medicine and Internal medicine, it is apt to discuss this here. Besides its good for IMGs to know what mess are they getting into ;-) LOL

TELL ME ABOUT YOUR WEAKNESS 1. "I have rather found myself impatient when it comes to teaching others - especially junior medical students. However I realize that teaching is an excellent way to reinforce my own memory. I now look for opportunities to teach as and when possible, the latest opportunity I had was when I held a rapid midnight tutorial on managing diabetic ketoacidosis for medical students who accompanied me while on call. I hope I will have ample teaching chances at your program" 2. "I usually find myself nervous and anxious while talking to a large group of people. But I have realized that sharing information on conferences is how doctors and researchers advance the science of medicine. It is an important skill to have and I have been taking every opportunity to make presentations in class, conferences, observerships. etc. I think I am getting better and more comfortable :-)" 3. "I have had a problem being organized when there are too many deadlines to meet, so I have been using my iPhone / PDA / written memos / to-do lists to keep myself on top of things. ..which has surely made me a better performer" A more mature and sincere reply might be "I am shorttempered when stressed, and now I exercise during my lunch hour to reduce my stress and control my emotions." Albeit, this is more risky, but also more interesting and insightful than the watereddown version 4. "I have not been able to focus my academic interests on any single medical area, I find too many areas fascinating, which I think is a weakness that can potentially keep me from being an effective contributor. This has made me a little reluctant to decide on one choice of a specialty, though I do know that i like being in a research environment and would like to do a dedicated fellowship" 1. One terribly cliched answer that you should stay away from = "I am a workaholic...causes an imbalance in my personal life". Someday I might get to be faculty and interview the hell out of you fellas and if I hear this 'workaholic' reply, I am gonna give you the most sarcastic grin you ever saw and say - Oh Really ! HEALTH CARE DELIVERY SYSTEM IN THE STATES: Highlights - The most money spent on biotechnologies, with 80 % spent by private sector in R&D - NIH funds basic research only - Highest health care spending per GDP, yet highest infant mortality - 30% goes to hospital, 20% to physicans, 23% to diagnostics, 10% to pharmaceuticals. - In 2007, the U. S. spent $2.26 trillion on health care, or $7,439 per person - The highest-spending 5% of the population accounted for more than half of all spending - Acute hospital care accounts for over half (55%) of the spending for Medicare beneficiaries in the last two years of life, tho it was found that this doesn’t improve life expectancy

- prevention does not produce significant long-term costs savings. Preventive care is typically provided to many people who would never become ill, and for those who would have become ill is partially offset by the health care costs during additional years of life. - without health insurance coverage at some

time during 2007 totaled about 15.3% of the

population, or 45. 7 million - almost 82% have insurance, 56% provided by employer, and 8% bought individually, rest by govt institutions - dental and vision care are bought separately and not covered - COBRA and HIPAA regulate insurance companies; (consolidated omnibus budged reconciliation act), allows employees to have health care even after they leave the employment. Same for Health insurance portability and accountability act. - providers (hospitals and doctors) can refuse to accept a given type of insurance, including Medicare and Medicaid. Low reimbursement rates have generated complaints from providers, and many hospitals have stopped taking Medicare patients. - Masachussetts, new jersey and san Francisco, Connecticut, have charity care to those who cannot afford. - EMTALA: emergency medical treatment and active labor act: cannot refuse emergency treatment, but ER treatment is costly than urgent clinic care - Most employee health is covered today by managed care organization, like HMO or PPO; aka health maintenance organization and preferred provider organization respectively, which negotiate with care providers and pay low prices than out of pocket prices. There is copayment or deductible involved. Capitation is the amount paid to provider every time the patient uses his care, no matter how much- this is the incentive system to persuade the provider to give less care. Primary care provider acts as a gatekeeper to decide if specialist is required. Likewise, any costly procedures usually need a second opinion before being approved. Pts going out of the network are charged extremely high. - PPOs have edged out HMOs. It is common today for a physician or hospital to have contracts with a dozen or more health plans, each with different referral networks, contracts with different diagnostic facilities, and different practice guidelines. - The first HMOs in the U.S. , such as Kaiser Permanente in Oakland, California, and the Health Insurance Plan (HIP) in New York, were "staff-model" HMOs, which owned their own health care facilities and employed the doctors. They focus more on preventive aspect. - Govt run community clinics, and certain county hospitals provide free care. Child health insurance program for those who earn too much to qualify for Medicaid, but too less to buy insurance themselves.

- There is no taxation on employee health service, which distorts the whole system, bcoz people who buy their own care have to do so after tax cut from their income - Medicare enrollment is increasing due to baby boomers - Health savings account is also tax exempt, but it benefits rich more than the poor - 15% of 300 million population is without care of any kind. Some say 30%. They usurp 30 billion of uncompensated care - Massachusetts has adopted a universal health care system through the Massachusetts 2006 Health Reform Statute, Health Safety Net Fund for those who cannot afford insurance - In July 2009, Connecticut passed into law a plan called SustiNet, with the goal of achieving healthcare coverage of 98% of its residents by 2014 - Federal Medicare and Medicaid rules forbid private healthcare providers from setting their own rates for these programs. physicians are not allowed to "opt-out" if they provide services at any healthcare facility that accepts these programs - McCarran Ferguson act allows states to control insurance policies without interference from federal government. - survival rates in the U. S. for a broad range of cancer types are the highest in the world, - the proportion of low birth weight babies may be affected by factors other than health care like Teen motherhood - mortality gap between the well-educated and the poorly educated widened significantly between 1993 and 2001 for adults - 1% increase in the unemployment rate would increase Medicaid and SCHIP enrollment by 1 million, and increase the number uninsured by 1.1 million - Many primary care physicians no longer see their patients while they are in the hospital. Instead, hospitalists are used. This fragments care. - There

are hundreds, if not thousands, of insurance companies in the U.S. This system has

considerable administrative overhead, far greater than in nationalized, single-payer systems, such as Canada's - numerous causes of increased utilization, including rising consumer demand, new treatments, more intensive diagnostic testing, lifestyle factors, the movement to broader-access plans, and higher-priced technologies - cost shifting- due to low embursement by medicare, hospitals charge higher to private insurance companies, thus increasing the overall cost. - 37% reported that they had foregone needed medical care in the previous year because of cost

- A lack of mental health coverage for Americans bears significant ramifications; The Paul Wellstone Mental Health and Addiction Equity Act of 2008 mandates that group health plans provide mental health and substance-related disorder benefits - An estimated 5 million of those without health insurance are considered "uninsurable" because of pre- existing conditions; people seeking to purchase health insurance directly must undergo medical underwriting. Insurance companies seeking to mitigate the problem of adverse selection; - minority groups have higher incidence of chronic diseases, higher mortality, cancer incidence rate among African Americans, which is 25% higher than among whites, DM, HIV, IMR, and cardiovascular disease - black Americans received less health care than white Americans —particularly when the care involved expensive new technology. - EMTALA is the key element in the safety net for the uninsured, but the cost is never fully reimbursed by the federal or state govt to the hospitals. EMTALA is an unfunded mandate that has contributed to financial pressures on hospitals in the last 20 years, causing them to consolidate and close facilities. emergency room visits in the U. S. grew by 26 percent, while in the same period, the number of emergency departments declined by 425. Some hospitals make pt pay by fee per service system, but many cant pay, and go into bankruptcy when hospital sues them. - the majority of the cost differential arises from medical malpractice, U. S. Food and Drug Administration (FDA) regulations - an FDA ruling went

into effect

extending protection from lawsuits to pharmaceutical

manufacturers, even if it was found that they submitted fraudulent clinical trial data to the FDA - many other countries use their bulk-purchasing power to aggressively negotiate drug prices, governments of such countries are free riding on the backs of U.S. consumers. US consumers are thus effectively subsidizing cost for other

nation’s consumers, so the lobbyists of the

pharmaceutical companies say. - Bush passed an act to prohibit drug price negotiation for Medicare, thus giving power to companies to profit off the Medicare. - Democrats prefer universal health care, while Republicans don’t

- the lack of health insurance among the self-employed does not affect their health, a study has shown - Advocates for single-payer health care often point to other countries, where national governmentfunded systems produce better health outcomes at lower

cost. Opponents deride this type of system as "socialized medicine"

- in 1973, the federal government passed the Health Maintenance Organization Act, which heavily subsidized the HMO business model. The law was intended to

create market incentives that would lower health care costs, but HMOs have never achieved their cost-reduction potential. - Around 7500 per head per annum is spent on health care - High drug cost in the states is due to lack of government price control, and implementation of intellectual property right. - Health care cost of Medicare are rising steeply - uninsured are unfairly billed for services at rates far higher—305% in some



California—than are the insured; USA Today concluded that

"millions of [uninsured patients] are forced to subsidize insured patients - 44, 800 excess deaths annually in the United States due to Americans lacking health insurance; and almost 100,000 due to lack of medical care - Clinton signed Medicare Prescription Drug, Improvement, and Modernization Act which included a prescription drug plan for elderly and disabled Americans.

Before that, medicare didn’t cover prescription drugs. - Barack Obama called for universal health care. His health care plan called for the creation of a National Health Insurance Exchange that would include

both private insurance plans and a Medicare-like government run option. Coverage would be guaranteed regardless of health status, and premiums would not vary

based on health status either. It would have required parents to cover their children, but did not require adults to buy insurance. - HIPAA includes electronic data interchange schemes like EDI Health Care Claim Transaction set, EDI Retail Pharmacy Claim Transaction (NCPDP national

council for prescription drug programs) - Health Information Technology for Economic and Clinical Health Act (HITECH Act), - HIPAA has affected research adversely.

- Proponents of health care reform argue that moving to a single-payer system would reallocate the money currently spent on the administrative overhead

required to run insurance companies in the U.S. to provide universal care - Malpractice liability has resulted in defensive medicine. Tort reform act are suggested as a way out. - Massachusetts' law forcing everyone to buy insurance caused costs there to increase faster than in the rest of the country - Eliminating the profit motive will decrease the rate

of medical innovation and inhibit new

technologies from being developed - Healthcare rationing- acc to age by medicare, acc to economic status by Medicaid, acc to employee status by EHS, acc to preexisting illness. And acc to how much you can pay. Other countries, by contrast, ration healthcare acc to need. In America, this rationing means there is no triage by need. Physician gatekeepers are also key in rationing. WHAT ARE THE BIGGEST CHALLENGES FACING HEALTHCARE DELIVERY ? a. The steeply increasing cost is the biggest challenge facing the health care delivery system. Health care has become more and more profit oriented. b. Physicians are practicing more and more defensive medicine, sending unnecessary investigations. This has made health care in the US 4 times as costly as in other developed nations of the world. c. Plus the gargantuan overhead/administrative cost related to the hundreds of insurance companies and HMOs is causing less money to actually go into the health care of the people. US spends almost 15% of its GDP on health care, highest among all developed nation, and 30% of that goes to overhead cost. Due to this, the health outcome of the population is far worse compared to other countries, with IMR, Quality of life index and DALY comparable to middle eastern and African countries. d. Pharmaceutical companies are gaining a huge and ugly profit by selling medicines invented 50 years ago, on the name of patent rights. e. To control this, govt should set a limit on the profit margin that pharmaceutical and insurance companies can achieve. f. Single payer health system, like the universal health care talked of so often by President Obama, and like NHS of the Great Britain, might decrease the overhead costs associated with management. g. Tort reform to curb litigation on physicians would also decrease the unnecessary investigations that doctors do to defend themselves against any lawsuit. WHAT DO YOU THINK OF THE HOSPITALS THAT DENY SERVICES TO UNINSURED POPULATION? BE DIPLOMATIC WHEN ANSWERING INCENDIARY TOPICS LIKE THIS.

This is a very difficult question to answer. The EMTALA act requires hospital to provide emergency treatment including active labor management to all people, regardless of their insurance coverage. But after emergency management is done, many hospitals try to dump those patients to other safety net hospitals. Though this sounds unethical, the hospitals are compelled to do that because the health care costs incurred that way will not be reimbursed by either the insurance companies or the government; while many safety net hospitals are subsidized by the government. Infact many hospitals have closed down their emergency services after this act was brought into effect. And safety net hospitals like the cook County hospital of Chicago, are so overburdened due to uninsured patient population, that it has a significant effect on their quality of care. People have to wait for so long many even go without treatment for days. So I think the government should either find a way to insure those people who cant afford insurance, for example by publicly mandated health insurance system, or provide more funding for safety net hospitals all over the country. Govt should open more public safety net hospitals, so that the existing ones are not overburdened, and to

ensure that their quality of care doesn’t go down. Many states don’t have such hospitals, s o the patient might have to wait a long time or travel to get treatment, which is not ethical at all. That way both private and public health system can survive side by side in a healthy environment. WHAT ARE THE POSITIVE AND NEGATIVE ASPECTS OF THIS SPECIALITY ? a. The positive point, especially of primary care, is that we can manage the patient as a whole, with help from other specialties. We are in charge of everything that is going on in our patient, and we have to coordinate with different specialties. This is a very appealing prospect of medicine. Plus if we ever decide to specialize, there are a vast majority of subjects we can choose from, from interventional cardiology to interventional nephrology. We get to sit down and think and not rush around all the time like in Emergency medicine or surgery, which is why this specialty interests me so much. b. The negative aspect is probably the multiple subspecialties that this specialty is divided into. Superspecialisation is like a double edged sword. On one hand, it makes us good in a particular field, but on the other hand it takes us farther away from the patient. It makes us into mechanistic beings who are taking care of one aspect of the patient or the other, without any regard for the total well being of the patient. But I guess that is what the primary care physicians are there for. …. . c. We have a busy and stressful life, with limited time for personal and family life, compared to say radiologists, pathologists or dermatologists. But I guess if we can manage our time well, we can have a pretty decent personal life. And I am ready to sacrifice a part of my personal life for the sake of a clinical career. Clinics is just too addicting to leave. WHY DO YOU THINK YOU CAN BE A PRODUCTIVE MEMBER OF OUR RESIDENCY PROGRAM sample answer from another website by mike MD so something. I can bring a hard working, honest and dedicated resident to your program who does not shy away from his responsibilities. I get along well with everyone and as a resident I have the ability to work in a team as well as on my own. I am obsessed about learning new things every moment of my life through books and my surroundings. I have a very sharp observation and that helps me make tough medical decisions if I have to. Your program has certain strengths that perfectly match with

my qualifications. As it is a busy residency program with high patient load, my back ground in Medicine will help me fit in very quickly without much time needed for training. I have been living in US for a while and I am familiar with ethics and dynamics of medical practices here.

Geographically your program is an area with a diverse population. I am sure you have a very competitive pool of applicants, but based on my background and qualifications, Iam sure I will be a very productive member of your staff. QUESTIONS TO ASK THE RESIDENTS 1. What is the housestaff officer's general opinion of the program? 2. Is there a medical library close to the hospital and does it contain an adequate selection of recent books and journals? 3. Is there an adequate visiting professor program with other institutions? 4. How valuable are the conferences? 5. Are chart rounds conducted routinely? 6. What is the average number of patients for which each house officer is responsible? 7. Does the housestaff receive adequate clinical experience performing procedures? Who teaches these procedures? 8. What is the clinic schedule? Is there a continuity clinic? 9. Is an attending physician present during each clinic? 10. What does the housestaff officer think of the chair? What is the chair's background and reputation? Is the chair sincerely interested in teaching housestaff? Is the chair readily accessible to the housestaff? 11. Are emergency services readily available? 12. Do all wards of the institution have cardiac arrest charts and EKG machines? 13. Is a radiologist available 24 hours for consultation? 14. Does the hospital provide IV and blood drawing teams? Are lab results computerized? 15. When do rounds begin in the morning and at what time does the normal day end? 16. What is the on-call schedule? Does it change during the senior or chief year? 17. Is moonlighting permitted and is it available in the community? 18. Are meals provided free or at a discount for housestaff? Is there an evening meal? Is food available/provided at all hours?

19. Is parking provided? If so, where? 20. Are uniforms and laundry free of charge to the residents? 21. Is there adequate malpractice and disability insurance, including HIV disability insurance? Does the hospital provide health and life insurance? 22. What is the availability of housing and its average cost? Where do most staff live? If many staff people commute, what is the average commute time? Should there be a concern for safety in some areas? 23. Is there a housestaff association and what is its relationship with the administration? 24. What are the climate and general living conditions in the community? 25. What is the general atmosphere of the hospital? Is it a pleasant place to work? 26. What is the housestaff officer's opinion of programs at various institutions? 27. Is the stipend good enough for living in that community ? 28. Does the program stick to Residency Review Committee's (RRC) regulations about to sticking to 80- hour work limits for residents ? QUESTIONS TO ASK THE PD 1. What is the interviewer's general opinion of the program? 2. What is the general framework of the training program? 3. Is most of the program conducted in the major hospital? 4. What is the composition and caliber of the teaching and attending staff? Are they fulltime or parttime? 5. Does the attending staff participate in daily rounds and conferences, or is the bulk of the teaching performed by other residents? 6. What is the conference schedule? Is time for conference protected time? 7. Are there any teaching conferences specifically for housestaff? 8. Does the program allow for research by the housestaff? If so, does the department fund it? Is there an elective time in which to do it? Are there faculty mentors? 9. Are rotations in related subspecialties included in the program? 10. Which electives are offered, and at what periods during the program? 11. Are residents permitted or encouraged to attend regional or national medical conferences? 12. Have any graduates of the program ever failed to do well on the certifying exams and if so, why?

13. Does the chair plan any changes in the program in the near future? Is the director likely to retire shortly or remain as chair during your residency? 14. What are the chances of permanent local practice after residency? 15. Is there a pyramid system? How many cuts are made each progressive year? 16. What is the financial status of the institution? 17. Has the program or institution ever been put on probation or been denied accreditation for any reason? 18. What does the director think of the programs offered by other institutions? Which of them, if any,would the director recommend? 19. What were the results of the most recent "in-training" examination? Is a minimum score required to progress to the subsequent year? 20 . How many residents decide on fellowships ? How many succeed ? WHY H1 VISA? Because I not only want to train here, but also get valuable work experience in a high-opportunity setting of my choice after all the residency and fellowship training. J1 will restrict my choices to lowopportunity primary care areas on the waiver job lists" IMGs should probably NOT talk on this going-back issue unless specifically asked .. even when program directors ask the question: "where do you see yourself in 10 years" - stick to professional goals. .unless very sure of heading back or if you do not mind the J1 visa FROM ANOTHER WEBSITE \WHY AMERICA AND NOT YOUR OWN COUNTRY ? If it were an IMG Program Director asking you that question - your first instinct might be to blurt out : "Look Who's talking" or "If that was an issue, why invite me for an Interview" - hehe. ...but you gotta tone down and give an indisputable answer. You surely want to avoid any political or personal angles that your interview might take and handling the question diplomatically will only do you good. Here are some things Non-American IMGs could use: 1. America is considered to be the highest seat of medical education in the world with the best faculty, educational facilities, technology and research opportunities. I wish to take advantage of this opportunity, learn the way medicine is done here, gain experience for some years after that and then take back what I learn back to my home country to set up a private practice, hospital, clinic. etc.

2. My country currently does not provide competent education in the specialty that I plan to pursue after this residency. 3. If asked - "But People need you back there in your home country" - you could say something like: "Yes - I am aware of that and that remains one of the most pressing reasons driving me to secure the best medical education in the world that I can achieve". In light of the above questions, if asked 'So will you be getting back to your country ?' - I don't feel there is anything wrong in suggesting that you will, unless there are some valid political reasons like political refuge. "Yes - after I have served in this country for a few years and put on good experience feathers on my cap, I plan to head back home to establish myself as a physician with advanced training and experience" In all probability you might never encounter this question! Some of you may debate that it may not be right to commit anything - but I say - when You say you will head back, it's not a legal commitment you are making. The program director is not going to keep track of you. You are just sounding politically correct without blowing off too much steam. WHAT IS YOUR LEARNING STYLE Learning style- first i prioritise what to read, i get together good resources, then i scour the material once for a general overview, after that i highlight important points as i read again, and then make a shorthand note of the important points to make it easy to revise again. when it comes to learning skills, i first learn by watching, then i practice the skill in a dummy if its a procedure or on a normal person, like a friend, if it is a clinical skill, then after a couple of trials with dummy, i give it a try under the supervision of somebody who is adept in the procedure.Supervised autonomy and self directed learning are the core of my learning technique i was asked- what difference do you see between the health care delivery between your country and the States. this is what i said, more or less. a. In our part, the motto is doing the greatest good to the greatest no of people. Hospitals and ER are very crowded and stressful, so are the floors. So pt rarely gets individual attention from the doctors. Here, patients are cared for individually by doctors, which is nice. b. Definitely we are low tech in our part of the world, no interventional radiology, no fancy drugs like imatinib and rituximab. Only drugs which are being used for a long time are available, and we have to make do with them. No new investigative technologies like MUGA or PET scanning, ie no any radionuclide imaging. c. Even those treatment and investigations available cannot be afforded by many, so we have to rely on our clinical judgement more than anything. d. The doctor to patient ratio is very low, workload is high.

e. We don’t have electronic record keeping system, and no way of coordinating care between 2 centers. f. We have less fear of litigation in our part, so doctors don’t practice defensive medicine like here. In our part, whatever doctors say is the ultimate, patients don’t question that. That’s one of the reason healthcare is very cheap in our part of the world. g. The education level of general public is also not enough for patients to be proactive for themselves, so doctors have to decide on the best course of treatment most of the time. h. There is mostly no concept of healthcare insurance, so patients all pay their own bills, but the good part is that the cost of treatment, atleast in public hospitals, are very low and significantly subsidized by the government. i was asked 'what do you think the most difficult part of internship would be for you in this country ?' answer: one thing that would be difficult for me in the beginning would be to give complete autonomy to the patient regarding their healthcare. in our part, the literacy rate isnt that good, so we could rarely take informed consent, no matter how hard we tried to explain the facts. so we had to make many decisions in the best interest of the patients. here, patients are quite educated and can make their own decisions. i would have to learn to give complete autonomy to them even in the smallest things concerning their healthcare another answer Toughest aspect will probably be doing the right thing, and keeping abreast of all the developments in the EBM that is changing the way we practice medicine day by day. Keeping track of new recommendations, like PPI improving COPD patients, and those unrelated and seemingly weird things, that is quite a challenge for a clinician. The standards and the recommendations keep on changing, and to be at the top of my game is really a challenge for us all. the same q here: " the most difficult part of internship for you".. ."diff bw my med school or my previous experience and the US" hummm.. ..ur answer is really guud.. ..however, my univ back home was pretty equipped with advanced tech in med research. .., then i had to work in dif parts of the world, so i had no ideas wht to say to be short! my answ: i have practiced med in different areas of the world and i feel confident to handle difficult challenges. i added . .." US has the best med tech and residency training. ... " That question asks for specific accomplishment in your hospital. - Implementation of screening programs? - Leading committee of prevention medicine?

- Creating new educational programs? - Change in how clinic is run? Patient assignment? Recruitment of nurses? - Implementing a new research program? Most difficult part of the internship is almost equivalent to the question what do you think are going to be the challenges you are going to encounter during internship: You can add things like: 1. Difficulty in balancing your private life with your professional life 2. Difficulty in having to study to advance your knowledge while fulfilling your intern duty in a very busy year 3. Difficulty in handling difficult and aggressive patients 4. Difficulty in dealing with nurses who do not agree with your plan of care or fellow residents who might disagree with you. 5. Difficulty in adjusting with a new culture, a new system which you guys touched on in your answer. One of the keys in answering this question is to let the interviewer know that you believe you will overcome those difficulties given that you have been confronted to such difficulties in the past. Let them know that you have done clinical work on the US and that has given you the opportunity to be better prepared to deal with upcoming difficulties. HOW DO YOU SEE YOURSELF ADAPTING TO THE HEALTHCARE SYSTEM OF THE STATES a. I like i. orderly workplace in the US hospitals, ii. the nice electronic record keeping system which gives access to every information about the patient at the click of the mouse, iii. the protocol and guideline based health care,

not putting the patient at the mercy of a

doctor’s whim, iv. the capping system on the number of patients any particular housestaff has to handle, v. the ACGME rules/ RRC (Residency Review Committee) on the hours on duty that are usually

followed around the US, so that the staffs aren’t overburdened. vi. I like the sharply defined roles between different specialties and ancillary staff, so that I don’t have to run around doing everything for the patient like I had to back home, from drawing blood to transporting patients or doing bone marrow aspiration. Of course I can handle a little bit of everything, but in our part of the world, it was so overwhelming that it resulted in too much chaos, and caused poor patient care.

vii. Considering these facts, I think I will actually enjoy working in US healthcare system. One thing I have to adapt to, however, is not making the decision for the patient, and giving him complete autonomy over his body. WHAT CAN YOU CONTRIBUTE TO OUR PROGRAM ? a. I think the clinical experience I gathered during my internship in my medical school will definitely help me take care of patients better. My teaching experience in China will probably help make the program more didactic for everybody’s benefit. My volunteering at Cook County Hospital will also add to the efficiency of this program during my internship, I have no doubt about that. b. my friendly nature, my devotion to patient care, my interest in academic activities and updating myself with the latest evidence in medicine, and my ability to get along with patients from diverse cultures will add to the efficiency of your program c. I am interested in clinical research so that we can improve our patient care make it more evidence based. I plan to not only work as a clinician, but also conduct some research in different aspects of medicine, so that I can bolster the practice of EBM HOW WILL YOU AS A PHYSICIAN HELP TO CONTROL THE RISING HEALTHCARE COSTS. a. Send less investigations, use my clinical judgment instead; b. try to cutdown the days any patient stay in the hospital; many patients stay in hospital for investigations that can be done on an out patient basis. This costs thousands of dollars each day. I will try to make sure that patients stay in the hospital only for the minimum days required. c. Also I will focus more on preventive medicine, like patient education, vaccination, early diagnosis and treatment of chronic diseases like cancer, heart diseases, HTN and DM. If pts come with complications, it takes far more resources to take care for them. DESCRIBE THE WORST ATTENDING YOU HAVE EVER WORKED WITH ?

b. Worst attending was when I worked in internal medicine itself. He used to come late, didn’t attend the morning reports he was supposed to attend and give feedback to the residents, never did his rounds on time( we had to wait for him to come and start the round), the patients rarely saw him, he was very arrogant and abusive towards both the patients and the residents and medical students. He had a private practice, and always used to leave early for his private practice without any consideration for his patients in the hospital. He even used to refer his hospital patients to his private clinic, in front of us. He was the incarnation/ personification of what a clinician shouldn’t be like. I used to say to myself this is how I should never be. WHAT KIND OF PATIENTS DO YOU HAVE TROUBLE DEALING WITH ? a. Yes there are certain personality types that are difficult to handle, especially patient who

don’t respect the rush we are working in and always want everything to be done then and there, have a lot of time pressure, and don’t realize there are other patients under our care too.

b. but I try to act professionally with all of them, and put extra effort to make them comfortableafter all I understand everybody becomes selfish and stubborn when they are sick- its like a defense mechanism. WHAT IS YOUR ENERGY LEVEL LIKE ? HOW DO YOU HANDLE STRESS ? HOW DO YOU HANDLE DEATH ? a. Well when I was in medical school, there were too many patients, not enough physicians. So a single firm would have to see almost 30-40 patients, and we had to stand for 3-4 hours in the round, and another 4-5 hours taking care of inpatients, then we had to do nightfloats which would start at 6 and end at 5 pm the next day, almost 36 hours. I have survived that, so I feel like I will

survive residency. On top of that, we don’t have crazy work hours like that in the US, atleast here, coz I have heard that this hospital strictly abides by ACGME rules. Working some extra hours a day is really not a problem for me, but very taxing schedule like in some NY programs- its really very difficult to handle. People here know that residents function poorly if they are sleep deprived. So infact I would be very comfortable working here. a. I have worked for one and a half month in ER of our hospital in my final medical year. It was one of the most crowded, most stressful ER I have ever seen. Lack of adequate ancillary staff compounded the problem even more. We had to handle multiple patients at once, send the bloodworks ourself, open the lines ourself, insert Foleys and NG, do blind LP because there were no USG guided procedures in our hospital. So it was pretty stressful. b. I have been though a lot of deaths in my ER postings. Initially it made me feel kinda queasy, but I got used to it later on. We start feeling mechanistic after a point, as if the human body is just the heartbeat seen on the monitor, and if we cant revive that beat on the monitor, then the person is

dead. We try our best, but there is no point worrying about what we couldn’t do. The more difficult part is to make the patient’s family come to terms with it. 1.why this program (all asked this) 2.tell me about yourself (whatever i prepared before did not work for me.. .I kept changing my answers in each program;hopefully they wont catch the discrepancies in my answers, lol) 3.why this specialty do you deal with adversity do you deal with a failure did you manage your personal life with the pressure of the medical school(I did not obviously but , again they dont know that!)-I just graduated.. this may not be relevant to all applicants but they might change it how do you manage your personal life with the pressure of the Match or something else. 7.what did you learn from your patients so far? is there any particular patient that thought you something that so valuable for you? 8.what regions did you apply? research..One asked me to explain what I was trying to accomplish with that research. 10. how in the earth you have that much time to travel? (it was a real question!) 11. what took you so long to go to the medical school (in my case it took me >zillions years to go to the medical school. ..for most here in this forum this might be an irrelevant question as well) 12. .tell me what you do in your spare time.. .(like they did not read my PS!) 13. what places have you lived in the US or in the world? 14. one person was particularly interested in the country of origin. ..dude was mesmerized with my country

bottom line: 1. I was never asked medical knowledge. My stellar triple 99s scared the hell out of them,lol 2.No embarrassing or unexpected questions. . 3. I was welcome there. I felt "They want me so badly!!!!"LOL LOL LOL) OK. ..I might be delusional at times..hahaha... . 4.In one place the PD took me to a very nice restaurant for lunch-one to one... and the PC gave me a city tour with her car- YES they did. .. 5.Nobody offered me prematches.. 6.They said call, write if you have questions.. 7. Everybody was very relaxed, comforting, made me feel on ease. 8. I was encouraged to ask questions: but I am told before that I am a nosy person (haha), so I have had alot of experience asking questions in general; At

one place, one of the faculty said" wait I have some questions for you!, LOL-seriously.. .I had him talk all the time, please dont ask me how I did that!!!!!!!) What do your parents do? Is anybody in your family a doctor? Do you play any musical instruments? What type of books do you read (because I had put in my hobbies/interests that I like to read.. .I was not prepared for this question) How do you deal with stressful situations? apparently the interviewer was just looking for a "I deal with itwell" type of response, but I was confused for a minute or two Do you want to do inpatient or outpatient in the future? Where do you see yourself 10 years from now?

What have you been doing since graduation from medical school? Do you have any special interests within (the specialty)? How did you hear about our program? Do you like to do procedures? What are your talents? (I was confused on this one too and answered with what I had prepared for my strengths) The most common question I was asked was. .... .. Do you have any questions? 1. what makes a good FM/IM/Peds? doctor? 2.why this program (again again is asked) 3.where are you from? 4.tell me about your family? 5what do you do in your spare time? 6.tell me about your hometown. 7.when did you decide to become an FM/IM/Peds? doctor? 8. what are you gonna do after your residency? 9.what school are you from? 10. do you have questions for me? 11. how old are you? they have rules;no teenage doctors in the hospital, lol 12. what is the meaning of your last name? 14. why that fellowship?

1.Do you know how difficult the residency is? Hi I had my first IV on friday, and I would like to share my experience.I had a pleasnt experience, the team was friendly, though i am not sure what all they were looking silently in me. The Qs I had, 1)All in very very detail about my experience, how I managed my patients in the past. 2)What are all the things you put together to come to USA? 3)Why this program? 4)why this place? 5)what do u want in your future?

6)I am married, so about husands job, is he interested in coming as well and what are his plans and so on. 7)About my interests. 8) any interest in particular subgroup ( thats how they asked ), I talked aboutsubspeciality/fellowship ideas of mine. 9)Any interesting clinical case that I have seen so far. The other interviewer asked me from a very particular job, so i had to quickly think and react there. Unfortunately they didnot give me an opportunity to talk about my strenghts which i had prepared so very well.(LOL) IM IV- tell me a challenging/interesting/complex case? - if you notice that an attending is doing something wrong, how do you deal with that? - why this specialty? - future plans? like after residency my friend erg was asked these questions: 1. tell me how your parents treated you when you were a kid. (badly, lol) 2.what if you dont match, do you have plan B? 3.where do you see yourself in next 5 years 4.where else have you applied will you do residency while you are in different state 6.then asked age of children,then asked how will you manage both. Here is more questions my friends got this season: 1. what "age" did you decide to become a doctor/surgeon/psychiatrist? 2.did you think that medical school was hard? 3.why did you get married/divorced/separated (whatever applies to you, basically). 4.what if you dont like this residency program? you have family with you here in the US? 6.where is your next IV? where are you coming from? 7. where do you reside now? do you make living now?

bottom line is any "personal" question can be asked -YES against the rules. One of the general questions also was "How much you are committed to this program?" "Who recommended this program to you?" more Qs, 1)If I give you give a magic wand and you have only one wish, what would you wish for? 2)where do u see urself in 5-10yrs of time? 3) how proactive are you, would you sign the contract now itself if u r offered a prematch?( they haven't offered me any prematch though, so sad, I wish they had) These were the questions asked to me during my 4 interviews 1. Tell me about urself? 2. What are your strengths and weaknesses? 3. How do you handle a stressful situation? 4. What are your stress busters? 5. What will you do if i give you 100 million dollars and ask you to spend charitably? 6. Dont you think that you are over qualified for our program? 7. If you had completed IM residency already at home country, why do you want to do it again in US? 8. What is your visa preference? Why? 9. Where do you see yourself after 5 years? 10. What sub-specialty do you wanna pursue? 11. Are you married? 12. Why arent you married till now, that too being an Indian? 13. What is your girlfriend doing? 14. Does she have plans to pursue her career in US? 15. How are you going to help her with her career in US? 16. What will you do if you think that your senior resident's knowledge is less than you? How can you cope with it? 17. How will you handle a junior colleague who is not doing his work properly? 18. Do you know to drive a car?

19. Do you know type-writing? 20. What do you want in a program? 21. How do you want us to train you? 22. What will you do if you dont get fellowship of your choice? Do you have a plan B? 23. How are you going to cope with this great transition of shifting from India to US? 24. How many ivs do you have? 25. Where else do you have ivs? questions I got in two IVs 1. what makes a good primary care doctor? 2.tell me why primary care is important. 3.why this program? many Ivs did you get? 5. Is this your first Iv? 6. why should we pick you over others? 7.why did you become a doctor? did you like the hospital tour? 9.what restaurant did the residents take you last night? 10. did you apply IM/FM as well? 11. can you live in this city? 12. do you need visa? 13. tell me about yourself 14. do you have questions to me? more questions I have got in IVs: 1.if you could be a tree, what type of tree would you be? My answer was : A salix tree!!! 2.could you work for free? NO! 3. why do you want to do fellowship in XYX? 4.did you fly here? You did not fly here? Did you drive then? was it easy to drive? you have any ties to this state? is your family in this state? you own a house? a car? do you have debt? does your best friend describe you? 9. do you like your hotel that you are staying? thank you so much nobody asked me "tell me about yourself" recently!! As self centered as I am , I am tired of this question! some more questions I have got:

1. how do you deal with difficult family memebers of the patients? 2. can you go to ER now and admit a patient confidently? 3.what is the rotation that you liked the least or the most? 4. what did you do in your rotations ? what were your responsibilities? 5.what do you you like at this program? 6. why did you get such a low score? (it was not 99!) 7.what was the most difficult time in your life? how did you deal with it? enjoy it.. . others? some more questions I have got: 1. how do you deal with difficult family memebers of the patients? 2. can you go to ER now and admit a patient confidently? 3.what is the rotation that you liked the least or the most? 4. what did you do in your rotations ? what were your responsibilities? 5.what do you you like at this program? 6. why did you get such a low score? (it was not 99!) 7.what was the most difficult time in your life? how did you deal with it? others? what qualities make u a good team member? - If ur resident who is inexperienced than u asks u to do something which is wrong, how r u going to deal with it( they asked me this Q as I have 2yrs of clinical Experience) - why this place was the question I faced in all the interviews I had so far? - As I have a kid, they asked me how I am planning to manage with my kiddo?

- Intersting case so far, especially involving genetics( the interviewer was specialist in genetics) - to explain regarding my experience and awards I got so far in detail? - regarding the hobbies I mentioned in the application So, I felt one should be through with your own CV (from A-Z) as they can ask you any questions on it. be prepared to face some unexpected Questions as well,

what ever it is answer them with confidence. 1.why did you wait and not apply to USMLE earlier? 2.step I low score. do you deal if your patient dies? 4.have you ever been sued before? did externship in radiology/surgery but not IM. Why? the rest was similar, tell me about yourself, do you have questions. here are some questions: 1.after the residency, are you going to go back to your country? you think you have got a good medical education at your medical school? 3. how is your medical knowledge? (excellent!!! LOL I tried to answer this in a way not sounding arrogant but did not want to look too modest either) 4.tell me about an interesting case that you have seen (finally somebody asked me this. it was the first time..) 5.okkk.. ..that was an interesting case, now tell me about another case. ( so one has to prepare more than one cases, looks like.) 6.have you ever worked in a rural area before? 7.where do you live now? 8. do you think you can work 16 hours daily? 9."are not you glad that ACGME decreased the hours of interns to 60hrs/weekly? What do you think about it? To others- I got a question while presenting a case of an interesting patient, of "what would be the differential diagnosis?" "what other tests would you order?" ... ...just a note that you should overprepare on the interesting case because you might get asked these and other questions. ..Know your interesting patient case through and through.

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