Thousands of articles have been written about how to prepare for and respond during a job interview. Regardless of the position or discipline, applicants are supposed to prepare themselves for a wide array of possible questions and scenarios. The interviewer's goal is to understand what the applicant is really like and whether she/he represents a good fit. Based on the forms and résumé, the interviewer already knows that the applicant has the requisite qualifications. The interviewer needs to determine if the relationship (if it were to occur) will work. There is only one way to do that. The more the applicant prepares for the interview, the more important it is for the interviewer to move the applicant out of their comfort zone. The employment experience will be filled with moments that no one can prepare for. So it is important to find out how the applicant responds to questions that are totally unexpected. The intent is not to create a trap. The goal is to mimic real life. That is why many in-demand employers (e.g., Google, Apple) are famous for asking out-of-the-box questions that force applicants to exit their rehearsed positions. These questions do not have a right or wrong answer. They only seek to understand how someone thinks and what motivates their sense of self. Do these principles apply to interviews in medicine? Physicians interview for many positions during their entire professional lives. They are interviewed when they apply to college, medical school, internship, and residency. However, because of the large number of applicants, these interviews are fairly perfunctory. Over 90% of the decision-making process is determined by applicants' written materials. Therefore, for many physicians, the first opportunity to be involved in a really meaningful interview comes when they apply for specialty or subspecialty training in a fellowship program. The fellowship application process typically involves a small number of applicants, and the interviews are carried out in person by the program's leadership. Why? The fellowship experience (if successful) is not necessarily finite. If everything works out, a successful fellow might be invited into a long-term relationship with the institution, either by joining the faculty or one of the practice groups that are closely aligned with the fellowship program. In essence, the departmental/divisional leadership is looking for people who will represent their future. There is little room for error. I know. For a decade (in the 1980s), I directed the cardiology fellowship program at Mount Sinai Hospital in New York City. Every year, our program would receive about 300-400 applicants. But we could only interview about 40 people. And we could offer only 4-5 new positions. The selection process was difficult. Most applicants were extremely well-qualified. They all had exemplary records of scholarly achievement from highly-regarded schools and programs. Their files were uniformly filled with glowing letters of recommendation. On paper, they looked very much alike. And on the day of their interview, they were all exceptionally well-prepared. Each candidate had practiced their answers to expected questions. Most also came with a personal story about why they were unique, why they elected medicine as a career or why they wanted to specialize in cardiology. I was always impressed with the preparations and presentations. But it was hard to know what to believe. As one might expect, many applicants simply told us exactly what they thought we wanted to hear, regardless of the truth. How could we find the true gems? To find out who the applicants really were and what they really wanted, I needed to circumvent all of their preparation and carefully crafted answers. My solution: I asked them one out-of-the-box question that (I had hoped) they had never heard before: "I can see that you are very excited about cardiology. But for the next few minutes, I want you to assume that cardiology does not exist. It is not an option. What then would you choose to do with your training in internal medicine?" Few candidates were prepared for such a question. They assumed that the interview was going to be about cardiology. But my goal was to discover the person underlying the applicant. So I had to take cardiology off the table. The answers were incredibly revealing. Some responded by saying they would choose pulmonary medicine. To me, that meant that they liked cardiology because of its involvement in critical care. Others chose gastroenterology or surgery. That signaled that they were becoming cardiologists because of their fondness of doing procedures. Still others offered general medicine as a second choice. That indicated that they were focusing on cardiology because they primarily wanted to be devoted to patient care. Finally, if the applicant's second choice was immunology, nephrology, or rheumatology, they were probably entering cardiology with a goal of looking for disease mechanisms. That meant that they were inclined to do research. (For the record, hardly anyone chose oncology. It was just emerging as an independent subspecialty.) After many years of interviews, I would periodically go back and see if my predictions were right. I found that I had been amazingly accurate. The question provided greater insights than anything that was available in their transcripts or letters of recommendation. Here is the best part. I know the question achieves its intended purpose, because it would have predicted my own career. In the 1970s, when I was interviewing for cardiology fellowships, I applied to many high-powered programs; all were looking for applicants who were committed to a research career. However, I had no interest in research whatsoever. I just wanted to finish my fellowship and go into the private sector. But during my interviews, when I was asked about my career goals in cardiology, I dutifully replied that I wanted a career in research. I told the interviewers exactly what I thought they wanted to hear. But it was certainly not what I was thinking at the time. What would have happened if one of the interviewers had asked me about my second choice? What if I had been asked: If there were no cardiology, what would I decide to do? Amazingly, I still remember what my answer would have been. Nephrology. I loved understanding disease mechanisms. That is what really made me happy. Not surprisingly, for the next 40 years, I spent my professional life in academic medicine in full pursuit of a research career that was devoted to understanding disease mechanisms. I never went into private practice. But when I was applying for cardiology fellowships, I would never have predicted my career trajectory for a moment. However, my quirky interview question would have instantly revealed what I really wanted to do -- even before I knew it myself. There is nothing magical here. Second choices reveal a great deal about people. That is the entire philosophical underpinning of "ranked-choice voting,"where second-choice votes are counted and play a powerful role in gauging the public's true preferences. Allan Gibbard (University of Michigan) demonstrated this in a mathematical proof in 1975. So now you know the secret. To find true happiness in life, you need both "second choices" and "second chances." Getting your first choice or achieving something on your first try may feel good, but it is not very revealing, and it is often not very durable. Source
