UW Medicine Town Hall 3 - The Interview

Uploaded by uwhuskies on 02.07.2009

Today were gonna talk mostly about the interview.
So here's what we're looking for during an interview.
...and the ability to think "on your feet" meaning in real time
if you're handed a problem what do you do with it at that moment
so communication skills can be broken down to a number of things, one is active listening
and, that just means, it's a counseling term. Active listening is really
just reflecting back to somebody what they've just told you
to make sure that you actually understood what they said.
And it's a key piece of relationship work.
Because you think you understand what somebody told you, but
you may or may not understand what somebody just said.
Eye contact is pretty important. We realize there are cultural differences
with eye contact, in some cultures it is considered disrespectful
to make eye contact. We don't always know that, and so as best you can
depends who interviewing you, whether they understand that or not.
The best you can, it's a good idea to make eye contact
with the people who are interviewing you. We'd like you to try and be as clear
as you can without going on and on and on and on and on.
There are some questions that you should be able to answer
very quickly, very short. There are other questions
that we want to hear more from you and the key is knowing the difference.
So when we ask you, why you want to be a doctor,
it's hopefuly in your personal statement,
we've read it before, we want to hear it from you, mainly as an opener
because you're expecting that question during an interview
and if we jump right in with a difficult ethical scenario,
we would make you very uncomfortable. So we usually start off with something we think
you've thought alot about, which is why you want to be a doctor
and you should be able to bring that to us in a sentence or two
really. That's a place for maybe a short answer.
The other is obviously making yourself understood so that we
know that what it is you're trying to tell us.
How do you get better at this? One is something called "toastmasters"
which is a national organization. There is a branch here at the University of Washington
I think there's more than one branch here at the University of Washington, and that's
a group in which particularly people who
are not so good, or uncomfortable with speaking, with public speaking
and they want to practice, and you go in with this group, they're often at lunch time.
You bring your lunch and they give you a topic of the day, and you just have to
get up on the spur of the moment and talk about it for five minutes.
And then the other people in the room give you feedback on that.
So it's just a way of getting used to talking to people you don't know.
Dale Carnegie wrote a book a long time ago
again, "How to Win Friends and Influence People"
and it was suggested to me by one of the premeds actually.
The third is practicing talking to somebody that you don't know
and this is a great pick up line, actually,
"I'm trying to apply to medical school, and I need
to practice my listening skills [laughing]
and would you talk to me?"
Who knows? Anyway, but again there you can practice active listening
like somebody talking, somebody says something to you and you say,
"This is what I just heard you say"
And you repeat what you think they said, and
see what they say after that. And then also just getting feedback
from the person you're talking to about whether you sounded clear
in what you said to them, or they didn't understand what you said
you know, and just getting feedback.
If you're talking to people that you know really well, they're pretty
sure they know where you're coming from, and so they're less likely,
they're likely to assume things that we won't assume when we meet you
because we don't know you.
So if you made some not so nice remarks, for example
and I were your mother, I would say, "I know you didn't mean
to be obnoxious, but you were when you said that"
Whereas somebody you don't know won't give you the benefit of the doubt.
So it's just a good idea to talk to people you don't know very well.
On the interpersonal skills level, we're looking for
empathy in particular. It's a critcal skill to have in medicine
and it's, I don't even know if you can learn empathy,
hopefully you can. To a certain extent it's just who you are
and it really means being able to put yourself in somebody else's shoes
it's not the same as compassion.
Compassion is more like, 'I feel sorry that this has happened to you'
Empathy is more like, 'oh my goodness, if I were in your position,
this is how I would feel and this is what I would do'
And, during the interview, either in a scenario
whether you are role playing, or you're just being asked a question,
you need to be able to put yourself in that other person's, patients shoes,
and try to work with them as though they were the, you know, you were
the patient at them. How would you feel
in that setting? We want to see if your respecting somebody else's
wishes and concerns, like it's called patient autonomy
in the medical scenario, but it's, if you're given a scenario
in which the patient wants something and you don't agree
with what they want, what do you do with that?
We hope what you do with that is that you try to ask
them questions to get a feel for why they're coming
from the position that they're coming from. Why do they feel that way?
Rather than saying, "No you don't understand, you really shouldn't do this."
You know, that kind of thing.
And again, being non-judgemental, I've already mentioned about
integrity, being non-judgemental means that even if you don't agree
with something, you're giving somebody the space to have their own
opinion and thoughts and cultures and backgrounds and, all of that.
So, being judgemental is one of those things that's sort of a kiss of death
during an interview.
If you put your own value system on somebody, and you're not
listening to them, and you're not even asking them what's important to them
that's really not good in an interview, or in your life in general.
And so, sometimes the interviewer, some interviewers will push you
a little bit, to the wall, where you'll be asking questions and they'll say,
"But you need to make a decision, you need to make a decision"
and that gets a little tricky and I think the way around that is to just say, "well based
on what I've heard" and "based on what I know" and "Taking this
into account" and "taking this into account, this is probably what I would suggest."
But really give all the reasons for it, if you're pushed to do something like that.
Maturity is a little difficult to define, but here are some of the features that
we think about when we're talking about whether we think somebody's
mature. Probably the key is how well that person knows him or her self.
In essence, that's really what it's all about.
So certainly the longer you've been around, hopefully the more mature you are.
That's not always true. Again, the more you try to take away from every experience
you have, the more mature your likely to be.
So again, knowing who you are, recognizing the needs of other people
clearly, whether you can function in the stressful situation.
And we really are not trying to make the interview a stressful situation
on purpose, it is inherently. And we recognize that, but we're not trying
to push you in that way. We expect you to have been responsible, it helps
if you've been on your own, you've been somewhere else
out of your home neighborhood, out of your home environment. And you
function well, in that setting. And of course coming in as confident
as you can seem without being cocky, is also something we'd like to see.
That you're comfortable in your own skin, really.
So, how do you get better at that? Well, we're back to experiences again.
Again, try to take some responsibility, try to get out of your own comfort zone,
and just get out there and live, basically, but try to again go out of your comfort zone
and where you've lived all your life. Whether geographically or ideologically
or something. And again, if you could try to journal, that will help. You could
ask other people for feedback. I was talking to somebody earlier today
about journaling, and we realized that some people have difficulty even doing that.
Like, how do you self assess if you're not good at self-assessing?
What I said was, try to ask yourself the questions that I would ask you if I were sitting there with you.
If you said, "I did such and such experience, and I had a great time"
and Dr. Tites would say, "well, what was great about it?"
And then you might say, "Well it was just fun" and I would say, "Well what was fun about it?"
And, things like that. And just keep pushing yourself to try to get more and more and more detail.
As this person said to me,
things were crystalized inside his or her head, and I said "that's great, but
you need to expose that to the public. Because, we can't see what's inside your
head, you know, so it all has to come out." OK, understanding a medical career.
This again is about making an informed choice so that we know
you're making an informed choice.
You should have some general understanding of the differences between
different types of practice. What it takes in the way of your time commitments.
In particular, whether, we mentioned earlier some people
who had said in the past they want to bench research in a rural setting.
Which doesn't make sense. Things like that. In terms of issues
that you should be aware of, they should be things that might be local health
issues, perhaps regional health issues, and national health issues
and, the list here is some of the things that might fall under that, and just
to give you some examples:
In a certain community, let's say, that there is a major problem with diabetes,
or a major problem with alcoholism, or a major problem with obesity,
and if you're from that community, and you don't know that,
that's kind of surprising to us. Because if you're somebody who's interested
in going to medicine and you come from a community in which there is
a specific medical problem in that community,
we would expect you to have an interest in that. Or at least know
that it existed. So we've had people come to us
from different communities around the region who don't know, for example,
that there is, let's say, a high rate of tuberculosis in their community.
Or a high rate of diabetes, or any of those things, and they're just not aware of it.
And so, when they're asked, "what are the health issues in your community?"
and they, kind of, "I don't know". Well, yeah, hmm.
You should understand, sometimes people will tick off this kind of a list in an interview,
and we know these things are out there on websites
and so, we would expect a little more thoughtfulness perhaps.
So, for instance, access could mean, transportation, people can't get
to where the medical care is offered. It could be that the clinic that
they're going to isn't open during the hours that they can get there.
It could be that nobody in that clinic speaks their language.
That's all access. So when somebody comes in and just
does a 'slam dunk' interview, they're telling us all those details
of things like that. That's the difference between an 8 on an interview
and a 6. This would be a 6 on an interview,
which is a good score. And an 8 on an interview would be,
"Well people work all day, and if the clinics are only open until 5 o'clock
and they can't take off work, they can't get there."
"They can't get babysitters, they can't get there." or
"They don't speak english, they won't come" or if they, you know,
that's a really superb interview.
In terms of the role of the physician in the community, again
we want to make sure that you understand that, most physicians
are not on pedestals. They are reasonably well respected, but if you need
to be on a pedestal somewhere, you're probably in the wrong profession.
And I honestly can't think of one where you would be on a pedestal.
These are some resources, and I'm not going to spend time
on this slide, because they're, again on our website
and they're all over the place. Probably if you 'Googled' health care
issues you'd probably find most of these.
I also want to mention that, for at least those of you who are
here at the University undergrad, still, that there are many, many prehealth
organizations, and they have mailings that they put out all the time.
Because I'm copied to some of them. And, they're always putting out things
like this. Resources where you can get more information, or
people that are coming in to speak, and, and things like that.
So thinking on your feet, this is more about, analytical ability really, and
again we put a sort of a basic outline of how to approach a problem
on the website. And you may get this in the form of
a case scenario, hypothetically or role play.
And these examples down below are some of the issues
we tend to ask questions around. And again we don't expect you to
be fully fledged, capable of talking about all this
in a well educated way in a sense that you learn some of this in medical school,
clearly. At the same time, you should have thought about some of these
on your own, and how you feel about them.
So for instance, end of life, you should have some kind of feeling
about how that sits with you, especially since the state of Washington
just passed a law about that. We would expect you to know that that happened
around here, and you should have some feeling about it yourself.
So that's the kind of thing we would expect. So the case or cases
that you will be presented may not all be ethical issues,
we don't always do ethics. Sometimes we do, sometimes we don't.
We just use that as a way to see how you think in real time.
And really what we're looking for is the process, more so than the answer.
That's very hard for people to get when they're applying, but
the worse thing you can do is jump to an answer.
So somebody gives you a scenario and you say, "I would do this."
That's a big black mark basically, or red mark or whatever color you like as an 'X'.
But generally if you're jumping to a conclusion, you haven't found out
where the patient lives, what's important to the patient.
What are they thinking about this issue?
You know, that sort of thing. So, sometimes people tell me
after the fact that they, this is what they were thinking, but again
we can't see inside your head. And so we don't know what you're thinking
unless you tell us what you're thinking. This is the place where you need to have a long
answer, rather than a short answer. What we want to know is,
do you have the, do you first understand the problem?
Do you have the ability to gather information?
Can you generate more than 1 solution if the scene changes?
So you might come up with one solution, and then your interviewers will say,
"Well what if this patient that I just told you about that was 16
is 80?" Let's say they need a lung transplant or something,
they just gave you a scenario, in a 16 year old, and now they're going to give you
the same scenario in an 80 year old, does that change your thinking?
How does that change your thinking? And we want to know about that.
So the solutions that you come up with should be informed by
data that your collecting on the spot, which should include the wishes of the
family and the patient, in the reverse order. The patient and the family.
And again, willingness to change your mind if something's different about the situation
that your being given. So I guess we're looking for some flexibility there.
I guess that's another word I didn't have in here.
So here's an approach, 1, and this is what we teach here,
we teach a problem based learning in this school and I used to run it.
So the first key is defining the problem. So if somebody's asking you a question,
it's not a bad idea to quickly repeat the question. Again that's active listening.
And you make sure you're answering the right question. So you want to make sure
you understand the scenario. And it's very easy to say very quickly,
"ok, here's what I understand that you just told me. This is the set-up, right?"
And then you tell us what you already know about that.
This wouldn't happen during the, if you're in a role play you wouldn't necessarily do that,
do it that way, but if you're in a hypothetical scenario you would tell us what
you already know about that problem. Let's say it's a lung transplant
person waiting on transplant list. You might tell us what you know about
lung transplants or availability. If you don't know anything about it, just
say, "I don't know anything about lung transplants, but here's how I would go about
getting information about it."
And, you need to recognize what you're missing. So when we teach this
in the school, we talk about, what's a problem, what do you know about the
problem, what do you need to know about the problem, how are you going to find out,
and what are your alternative solutions to that problem?
If you're in a role play, the way that you gather information is you're asking questions
of the patient, you're asking questions of the family members if they're in the role play,
that's how you're gathering information. And you're adding that
to the information you already have in your head. And when
you speak to the patient in a role play, you're mixing that all up
and putting it back out. So you might be saying,
"I hear you saying that you're afraid to have a lung transplant"
or "your parents are afraid for you to have a lung transplant because
they're afraid you're going to get HIV. From what I know about
transplants, it's highly unlikely that you're going to get HIV from a lung transplant."
Or something like that. So, you're combining what you heard from the patient and what
you know yourself. And then you might offer some solutions about
that situation. And again based on your solutions should be based on the information
that's going to reiterate the information as you present the solution.
So again, don't be afraid to say, "I don't know", but don't stop there.
So if you say, "I don't know", we all face that almost everyday
in the practice of medicine, we see something we've never seen before,
or we're seeing a problem in the type of patient we've never seen before,
or it has just a different presentation and we're, have to take a step back and
say, "this is different. What are we going to do with this?"
So, the reason this is so important to us when we're interviewing you is
this is a very common scenario in the practice of medicine that you're
faced with a problem where you don't, you don't really have the answers, or at least a
good answer necessarily. So then you have to step back and say,
"OK, here, what am I going to do about that?". So, when a patient's
in your office in that setting, you usually say, "you know,
I can", well I'll give you one example really quickly.
A patient that I had this past year that I've been seeing for 25 years
who started developing arthritis, it was pretty rapid, it was pretty weird,
and I said, "you know, I don't know what this is". And I,
we talked about different kinds of arthritis, and he says to me, "what about",
this is gonna be pretty bizzare, "what about hemochromotosis?
I've been reading about that on the internet."
To which I had to say, "Hmm...boy, I haven't thought about that disease in a long time.
Show me the site on the internet." So we pulled it up on the computer,
and sure enough he had the hand findings and he had the spine findings, and we
ordered the iron tests, and there it was. So it was really very cool.
But the point is that, the patient brought it up, and I didn't say, "oh don't be ridiculous.
Hemochromotosis, you're not gonna have that." You know, but...
And it would have been very easy for me to say that because it's usually a disease
which shows up when you're very young. It's an iron overload disease.
It's hereditary, the guy is 60 years old, never had a problem before. But it turned out
he'd been a blood donor, which is the treatment. He'd been a blood donor for
years and years and years and years, and only ten years ago
he got a really bad systemic infection and they wouldn't let him donate blood.
So it's a great, great example scenario. Anyway, sorry to digress.
Just tell us if you don't know something, say, "I don't know and here's how I'm going to
find out." And that works really well. Because we all do that.
So there's really no such thing as a wrong answer. Really honest, really really.
Trust me. [Laugh] But there are wrong approaches.
So the wrong approaches are, that you come to a snap decision,
and you put it out there with nothing, you're not saying anything to
tell us why you've come to that decision, you're judging the person, perhaps,
or you're imposing on the person, you're imposing your opinion on the person
when you disagree with them. Those are all three things that are,
really, really, negative in an interview.
Again, how do you get better at this? Well, here we go back to
practicing with others, yet again. So you have many opportunities
to make a lot of new friends. You should think about some of this ahead
of time. So again you're not, you know, the lesson the dark you are the more
comfortable you're going to be, really.
Here are some resources, which again you can get from our website.
We also posted a whole bunch of, somebody wrote in to us and asked
about resources for ethics questions, and I think we posted a few books
or something like that. And then I would suggest that you take a problem solving
approach to decisions you're making now, in your life, that have nothing to do with
medical school. And just play with it, and see how it works.
So if you're going to buy a car, how do you gather information about that car?
Do you first decide yourself whether it's about the color, or the style,
or the mileage, or the money? How do you decide that?
And then, do you go and look at, compare mileage of this car to this car
to this car to this car? You know, that sort of thing.
And then ultimately, how do you make the decision? It's the same process.
So here's a sample scenario and then we'll stop and go to the Q & A.
The sample scenario is:
And there are a number of issues that come in there, but here are some
things that you might say, that would not go over well. And three of them are negative,
sort of, and one of them is positive. And so you might feel really
good about yourself as an applicant of saying, "sure. Birth control, no problem.
I'll give it to you." That's still a wrong answer, and a sense of
wrong answer because it's the wrong approach. It's not a wrong answer,
it's a wrong approach. You just jumped to it a little too quickly.
Here are some things you might ask that person, not necessarily in this order.
"Are you sexually active?" Somebody's asking for birth control pills, do they
really understand what that's all about? Maybe they're asking for birth
control pills because they think somehow they won't get AIDS if they're using
birth control. Who knows? So, that's usually the first question, but
it doesn't have to be the first question. And then all of these others, "have you
considered other forms?" I wouldn't say, "have you considered..."
see I wrote it better than I said it. If you say, "have you considered you're
asking a yes no question?" And you're not going to get as much information out of
your patient as if you ask an open-ended question, which is
something like 'what'. "What types of birth control have you considered."
But these are just additional examples, um
"What's you're understanding of health problems that could arise from
having sexual intercourse?" See if they know anything about getting
um, sexually transmitted diseases, other than getting pregnant.
Maybe making some positive comments and trying to delve into
why do we not want to talk about this with you're parents? And it could be that
at the end you decide you're not going to talk to the parents, and that might be OK.
But again, you should have come to that for some reason.
And you might decide you would, just your own feeling, you would
prefer to talk to the parents, but you need to agree with this patient
if you're going to do that, or, "can we agree that I won't talk to your parents
until you've talked to your parents", or, "would you rather we talk to your parents
together? Would that work for you?" Or any number of things like that.
So you just need to be asking questions, don't just make decisions.