Disclaimer: This post was written before the COVID-19 pandemic. Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years.
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As a fourth-year medical student on the interview trail, I honestly did NOT realize that there were questions that people should not ask me. As I transitioned from medical student to resident to faculty member and first started interviewing applicants for our EM residency program, I was so nervous about questions I COULD NOT ask. I did not know what those questions were.
So let’s start with what you SHOULD NOT be asked during your interviews for residency...
(or for fellowship or a job or anything else…) (1)
Your demographics: Age, race, religion, socioeconomic status, ethnicity, sexual orientation, gender identity, national origin.
Family: ancestry, marital status, number of children, age of children, plans for future children
Personal: Height and weight, physical and mental disabilities, physical appearance, personal activities that probe for personal affiliations
Other programs or specialties, and ranking plans: Information about other programs or specialties to which they might be applying and/or how the applicant plans to rank your program
How prevalent are these questions?
WAY TOO PREVALENT - and this has been going on for decades. In 1990, an AAMC study found that 35% of applicants were asked questions about family planning and marital status, and 38% of female applicants for residency were asked about intentions to bear children during their residency interviews. (2) In 1996, 45% of all respondents to an AAMC questionnaire reported being asked similar questions.
In 2013, a large survey with 7,028 respondents found that 64.8% of applicants (4,557) reported that they were asked at least one potentially illegal question. (3) Questions related to marital status (54.3%) and if the applicant had children (27.4%) were most common. (3)
Women were significantly MORE LIKELY than men to receive questions about their gender, marital status, and family planning (P < .001). (3) Being asked a potentially illegal question negatively impacted how applicants ranked that program. (3)
One Disclaimer: It is important to note that if YOU bring these things up, then the interviewer can discuss them with you. For example, if you bring up that you are married with children or if you bring up that your family immigrated to the US and you are the first member of your family to receive a college degree, these statements allow the interviewer to ask follow-up questions.
How should I respond when I do get asked these questions?
So now, let’s tackle the question we SOOOOO commonly get asked… how to respond when asked these questions. We recognize that as a medical student, you are in a vulnerable position. Your career rests on you matching into a residency program. You have spent almost a decade preparing for residency, put yourself into potentially a few hundred-thousand dollars worth of debt, and just want to match. So HOW in the world should you respond when someone asks you a question that is unethical, illegal and biased?
While I could give you my perspective alone, I think one person’s view point on this subject is limited. So I posed this question “If you were a female MS4 interviewing for residency and you were asked about your intentions to have children during residency, how would you respond?” on Twitter in order to see what recommendations the twitter-sphere had for fourth-year medical students. I received over 100 comments with recommendations on how to handle these situations. There is NO correct answer. So I’m sharing a variety of answers in order to empower YOU to pick your style.
Answer directly and move on.
“Honestly, my focus right now is on finding the best fit residency program that will support my career goals.”
“I don’t have plans just yet, but 3 years is a long time for plans to change. Which is exactly why I’m looking for a program that will support me through these changes”
“Not if I can help it”
“That’s not what I’m focused on at the moment”
“I don’t know what the future holds but I’m sure I’ll figure it out like everyone does.”
“At this point in life, what I’m really looking forward to is starting my residency training, and focusing on being the best doctor that I can be. My life outside of the hospital has always served to make me more balanced and I hope to continue to foster that in residency.”
“You know I don’t know yet, right now I’m just focused on finding the right residency for me and then becoming the best doctor I can be.”(I got asked 6 times)
Respond with a question.
Many people recommended responding with a question instead of answering. This method of responding will allow you to seek out their motives and give them a chance to clarify their intentions (maybe they are pure) or to take back the question.
“Why do you ask?”
“Great question. How have your current house staff handled it?”
“I’m not sure I understood the question, would you mind repeating it?”
“I’m sorry, I don’t think I heard you correctly. Can you please repeat the question?”
“Can you please repeat that question? I just want to make sure I heard it correctly.”
“I haven’t thought about it: why do you ask?”
Turn the question around to get information.
Another group of respondents, recommended turning the question around in order to pose a challenging question to the interviewer about what the program does for residents that have families etc.
“I haven’t made plans to start a family, however I’m looking for an environment that would be supportive of my choices and treat me as an equal to my peers. How has your program supported trainees in the past that chose to start a family during their training?”
“Actually, I wanted to ask what supports the program has in place for parents (male and female) as well as people increasing their families, be it biologically or through adoption?”
“Thank you for this question ! I would be curious to know what accommodations are in place for pregnancy , child care and lactation support in this residency program?”
“Oh! I am surprised to hear a question that violates match rules. But now that you asked, would you tell me how the program supports residents who need maternity or paternity leave?”
“I would love to hear how you support residents with all types of life changes, from children to sick parents to moving and relocating. I assume that's why you are asking?”
“If you are asking that question because you are wondering if I can balance all of my responsibilities, I can assure you I have and I will.”
“How supportive is your residency to trainees balancing their career with a family? Do you find that your LGBTQ trainees feel equally supported? How do your parental leave policies compare with your peer programs? What lactation support do you offer?”
Call out the inappropriate question.
A final group challenged the question more assertively, which could be uncomfortable as a fourth-year medical student but is NOT out of the question. You really have to know yourself and consider if you will even rank this program before using one of these approaches.
“I don’t think that’s relevant to my clinical competence. I’d be happy to discuss any questions that you may have about my CV.”
“I don’t believe that question is neither appropriate nor relevant. I would be happy to talk about (insert achievement here).”
“How would knowing that affect my application?”
“I think it’s inappropriate to ask me that.”
“I’m wondering if you are asking male applicants the same question?”
Advice: I would inform them that question is an NRMP violation and cross them off your list! Every program should know not to ask. If they do, I’d be very concerned about what other rules they aren’t following!
Here is some other great advice from the responses:
‘I told the truth the one time I was asked. They didn't seem happy, so I didn't rank them. For all my future mamas out there, find a program that will support you.”
“Lying is never the right answer.... It's a good rule for residency and life. If you never lie, you never have to remember what you said.”
Agreed! Do not lie. Answer vaguely or refuse to answer at all if you are uncomfortable.
“I had an APD from a program tell me not to mention that I was married with a child because “it’s not relevant”. Conversely, they mean the world to me, and bring it up at all interviews because I want programs who have a variety of demographics and experiences.”
I agree with the student, NOT the APD! As humans (male and female), our families are ALLOWED to be a priority in our lives. Medicine CANNOT be our only priority. If you are in a relationship or a parent, where you choose to do your residency training is a decision that affects others. Their well-being should be considered. You want a program that is going to support you and your relationships with your family. You should feel free to bring up your personal life. Interviewers should not. Ask the residents questions. Ask the interviewers questions if you want. If someone is going to rank you lower because you have a family - that is NOT a good fit.
Response citing rules is adequate. HOWEVER, if you are planning on having kids, I’d recommend finding out how family friendly they are. If they aren’t, it’s probably not the right fit for you as a whole person anyway.
As a program director I asked that question once. The medical student said, “Do you know that you can’t ask me that?” I appreciated her mentorship.
This response is truly insightful. The person asking may NOT have meant any harm. Allow them to explain themselves. Gently correct them and see how they respond. We cannot assume that everyone asking inappropriate questions is evil. Get more info...
These responses are what PROGRAM LEADERSHIP should be doing:
“I let all genders of applicants know we have supportive leave policies, breast-feeding support and good places to raise families. We have great places for singles to live too. Your plans for your uterus and love life are private and not relevant to the interview.”
“I encourage trainees, rotators, students, really everyone to have kids sooner rather than later (if desired). Never a good time so just do it. Family = top priority in our culture here.”
What else can be done?
Notify the PD that one of their interviewers asked so that they can remedy the situation and prevent future female applicants from experiencing the same. If it was the PD, consider writing the ACGME or the NRMP to inform them. And if you worry about reporting a program because of retaliation, document all of it and submit after match or anonymously.
Here is a link to the NRMP policies and procedures. https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2015/08/Violations-Policy.pdf
You, as the applicant, will have to make a decision about the spirit that the question was asked in and if that program will fit you.
Consider who asked that question - was it a resident or junior faculty that maybe wasn’t aware of the rules or was it the APD or PD who should know better? Can you go to the PD and discuss that question and how the program approaches residents who decide to have children? Maybe you haven’t had your interview with the PD yet during that interview day. Overall, figure out the culture of the place and decide if that place should even be on your rank list.
As a medical student, you may feel helpless during the match process. Know that your rank list holds a lot of power. You do have control over where you go. Do not be afraid to move a program to the bottom of your list or not rank them at all if you will truly not fit at that place.
Here is the link to my tweet so you can read all the responses: https://twitter.com/MEParsonsMD/status/1188687067783385090
Best of luck to you during interview season and on the match. I hope this article prepares you to answer the hard questions that you shouldn’t be asked. Hopefully you do NOT need the answers you’ve prepared. Hopefully!
Sources:
1. Lead LS. Best Practices for Conducting Residency Program Interviews. https://www.aamc.org/system/files/c/2/469536-best_practices_residency_program_interviews_09132016.pdf.
2. Association of American Medical Colleges. 1990 Medical School Graduation Questionnaire, Summary Report for All Schools. Washington, DC: Association of American Medical Colleges; 1990.
3. Hern HG Jr, Alter HJ, Wills CP, Snoey ER, Simon BC. How prevalent are potentially illegal questions during residency interviews? Acad Med. 2013;88(8):1116-1121.