Psychiatry & Psychotherapy Podcast - Interviewing Well For Residency & Beyond

Episode Date: October 16, 2019

On this week's episode we will be covering a special topic-interviewing well-for psychiatry residency, and even in other interviews post residency. I am interviewing Neal Christopher, a 4th year, chief resident and the host of a podcast for the APA, The American Journal of Psychiatry Residents' Journal Podcast.  Link to blog. Link to YouTube video. AJP Resident Podcast with Dr. Christopher

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CMEE while listening to this podcast? Go to Psychiatrypodcast.com, sign up, sign in, take the test, and the certification is email to you in seconds.

Welcome back to the podcast. This is going to be a special edition of the Psychiatry Podcasts. and psychotherapy podcast geared towards people who are interviewing for psychiatry residency. But I think it will also apply as you think about interviewing either post residency or for medical school or just the process of going through kind of a competitive evaluation. But I want to flip the script a little bit. And I'm here with Neil Christopher. He is a fourth year resident who is a chief resident.

and he is an excellent resident. And I actually interviewed Neil back in when he was coming into the program. And he is also the host of a podcast for the APA called... It's the American Journal of Psychiatry Residence Journal podcast. Yeah. Or AJP.R.J. Yeah. And he's doing some good stuff over there.

So if you haven't checked that out, check that out as well. But in this podcast, what we are going to talk about is, how you interview the program from start to finish. So I really wanted to go through and talk about how you evaluate a program and if the program is a good fit for you. Because if the program is a good fit for you, then you will know how to rank them. You will know how to talk in the interview to talk about the things that you're passionate about that are linked to the program. And I think you'll come across as a great interviewee,

but also you'll be able to assess if this program fits your values and the things that you're looking for. So, Neil, how would you help someone understand what their values are, understand what they're looking for in a psychiatry program? I think to understand your values, I come at it from one of the psychotherapy approaches that I've done a little bit of extra work in,

which is acceptance and commitment therapy or act. And in there, understanding your values is one of the core processes. Now, values is not by any means limited to act. But it's a process by which I've learned to quickly help patients, even friends, identified the values and move towards committed action and expressing those values. So there's different ways you can think about it. One is just to think in terms of what thoughts or ideas do you want to move towards in your life over the long term.

What kind of person do you want to be? Another way to think about it is when other people talk about you, what kinds of things do you want to be known about yourself and to be said about you. And you could think of it in terms of a short term. If you want to be slightly morbid or funny, you could think of it as, you know, you get hit by a bus and what people say about you in a eulogy speech, what kind of person you were. Because those types of ideas are generally very much related to our values. another way to look at it is when we are particularly angry or when we are particularly anxious, it is usually because a value has been violated.

Either someone has violated what we perceive to be a value, or we feel frustrated and unable to express and move towards something that is important to us. And often these are unconscious processes, unless you've ever, met with a therapist or a life coach or a religious leader who has helped you to express these concepts that are important to you. Yeah, I really, I really appreciate that, especially, like, how do you want to be known? Like, if you were to die, what would you want people to say? What would you want your legacy to be? What would you want, like, if you were, like, awake behind a boat? What kind of wake would you want to leave?

what kind of like mentors or people in your life that are psychiatrists are the people that you look up to? And I would say also look at the people and the things that you like the most about them and try to create that sort of composite person that you're aspiring towards. Because I know I don't embody all of the characteristics of the ideal psychiatrist. So take the values that you can from each person and kind of put them together and kind of create like what would that? look like. I think that's a great idea and I've definitely learned that myself is when you find yourself drawn to a person professionally. This is someone that you aspire to have the same sort of success they have or work in the same field that they do or you even in terms of literature you find yourself really preferring or liking some historical figure and you're drawn to them or maybe as someone

you've read a biography or an autobiography of and you connected with it, that that's typically also because they expressed or their story expressed some value that's important to you. And it may not be that one person completely represents the same values as you. In fact, that would be highly unlikely. It's that whatever they're known for, whatever that brand or that story that's being told about them or however you understood that person in their career success is representing probably one or two values that you also hold. Yeah. Yeah. So pause this. Write down some of these things as they come to your mind.

You know, write them down because you want these to be in front of you. You want to actually see them. You want to write them on your mirror so you can look at them when you wake up. You want to look at these values. And then the questions that you ask, the research that you do about each program is looking at it in terms of these values. Do you think that's a good idea? I think it's a great idea. I would ask, think about all the things we've just said, ask yourself some questions like, what kind of person do I want to become, or what kind of person do I want to be, even if no one else ever knows it? Like, this is the person I am on the inside, even if I'm committed to becoming this, even if no one ever finds out about it. And make a list and start making that list now. I think another way of making your own values.

is to write down the things that you've valued about mentors or the ideal mentor you've had. So if you could write down all of the characteristics of the ideal mentor, the ideal supervisor, someone maybe who has high empathy, someone who's, it's safe to ask them questions,

and they don't get thrown off. They don't become reactive or angry back towards you, so they're psychologically safe. Maybe there's someone you can trust. right there's someone that you have similar goals with there's someone who receives feedback and gives feedback with grace um maybe some of these are the things that i look for in mentors you know and so you know writing down the things that you appreciate most in mentors that you've had can and then kind of flipping the script and saying you know what i would actually really value these

things myself so we have an interactive episode of the podcast so go ahead and stop and do that now. Yeah, do some of this. Don't just passively listen to this. Like, do the hard work, right? Sit down and journal this stuff. And maybe it's relisten to this first part a couple times until you get that sort of... You see which prompts caught your attention for some reason, caught your emotion, because those are the prompts that might help you identify something. And it's okay to change. If you've never done this before, it's a starting place. If you've done this a few times you might find that your values have shifted or your understanding of what's important to you has shifted. I used to go into a juvenile hall and I did it for three and a half years. I would talk to

the guys every week during medical school and I would ask them pretty much the same. I would talk to a different group every two weeks and I would ask them this question. It's the last day of your life. Okay. And who are you with? What are you doing? what do people think of you? How do people, what do they say about you, right? And, you know, all these guys, and then I would throw them a curveball, I'd say, okay, so you're in a large house.

How many of you want a large house? Everyone want a large house. Okay, so you have a lot of things. Everyone wanted a lot of things. I'm like, okay, you're a low in your large house with your things all day long. And they'd be like, no, no. I'm like, oh, oh, what do you mean?

Tell me. And they'd be like, we're with our friends, we're with our family. You know, we have grandkids with our great grandkids, you know. And little people, every single one of them wanted the things that we all want. We all want a good family. We all want close relationships. We all want close friends. You know, I want to build a department that we're close.

We hang out. We love working with each other. and having a culture with residents as well, that we like working, we like showing up and we like doing this together. Right. You know? Okay.

Any other thoughts? Well, yeah, I think that just the idea of, there are some things that are going to be relational, like you just mentioned, like who are you with? There's also aspects of, you know,

which kind of, what kinds of jobs would you do if you won the lottery? Like, what work would you do for free, even if no one paid you? And as we shift from, say, some of the values that are more internalized to the values that relate to more to the kind of career that we have, it might be important to think about that. Like, if you're interviewing, you know, for a psychiatry residency or for a psychology residency, clinical residency, then, you know, you want to look at programs and wonder about how they're going to relate to the kind of work. that you would do even if you didn't get paid.

Now, we all have tons of debt now, at least most of us, because of the education and training we got. So we're probably not going to be doing this work for free. But there are things you would do even if no one paid you. There are things you're doing in your off time. And those typically relate to values that you have. I like that question. I really do.

Like, what would you do if money was no longer important? And I think there's something, hopefully in psychiatry, if you're going into psychiatry, if you're going into mental health, hopefully there's something in this field that you would do for no money. You know, for me, like sometimes I feel like I'm almost surprised that I get paid for some of the stuff that I would do for free. You started the podcast for free. Right. Yeah. Well, I mean, I'd be surprised someday if I get paid enough where I could actually, like, like, you know, do this halftime. I would like that. You do a lot of extra supervision of

residents that is not compensated directly. It's fun. Right. It's fun. It's like a nice break from the day. I have a moonlighting gig where I, uh, helping run the clinical side of a residential unit. And, um, I teach one or two groups a month for free because I, I like the group work. It keeps me sharp and it helps me develop new ideas. It helps me learn to relate to the patients when, They're in a group and they're kind of unruly at times. And so I find that it keeps my skills sharp. And I find that the teaching aspect of group therapy that comes into play is kind of recharging and nice variety from meeting patients one-on-one.

One thing about Neil is he loves to teach. I remember when you were, I think a second year, and I gave you a lead on teaching a psychopharm class at a local college. And you did it. I'm still doing it. You're still doing it. I'm doing it right now. Dude, you do so much.

It's crazy. So what we're talking about, though, is these are the things, by the way, when I interview someone, these are the things I want to hear about. I don't want the wrote answers. Like, I don't want the answers that are prefabricated without passion. Like, I want to hear what people are actually into. And I think that's something that's unique about, like, psychiatry and the interviews is, more than anything, we're looking for the real you, the you that is passionate about this field

and that is something, and the things that get you up in the morning and that you would do for free. I think that you have to do something to stand out. Unlike interviewing for your professional school or medical school, what you're really hoping for there is that they just don't say no. because if they don't say no, then they say yes, because it's the only two options there are, right? And really, for those of us that went through the medical school process, we really wanted them to not say no. Because if they don't say no, we get in and we've made it, we're going to be a doctor, we're going to be in the career that we want it. But it's different when you move into your postgraduate training and any further degrees after that, because what you want is you want them to say yes. and you want them to say yes to you,

and you want them to say yes to you above other equally qualified people. I mean, this is not some people aren't qualified anymore. This is we're all equally qualified and really hard to disambiguate on paper. And when you look at the things, you look at the data that's published by the NRMP for matching, what stands out in particularly in psychiatry is that the things that matter after you have the interview in ranking, are all personal.

Can you go through some of that data? I can go through some of it. And you can get this. If you just Google NRMP, PDFs, you can find the references here. But the factor that is cited by 100% of program directors is interactions with faculty during the interview. That is the, every single person said that was important

in where they were going to rank there, the people that they interviewed. The next highest one, interpersonal skills that were demonstrated during the interview. The next highest was feedback from current residents. And medical students know this. This is one of their deepest fears that what is on, you know, what is the interview? And the answer is every part of it is the interview from the dinner or the social event the night before, the night after,

through the formal times when you're actually sitting with faculty, it's all part of the interview. The way you relate to the program assistant is part of the interview. And we really wait that, by the way. We've disqualified high candidates because they were rude to our program assistant. So take that for what it's worth. Like the people you interact with and how you relate your value, and what you're looking for is important.

Go ahead. Yeah, I was just going to finish up by saying it's just really interesting when you look at it that everything that's above 70% has nothing to do with board scores. Sorry, that's false. Everything that's above 80% has nothing to do with board scores. It has to do with who you are

and how you talk and relate to people and how you react in the interview process. And those are the factors that, are most influential as program directors do their final ranking. Yeah, and I think that's, I think it's largely because, you know, people are going to rule out board scores before the interviews. So if you have an interview,

you're in a grouping of people that's probably fairly similar. And at some point, you know, in psychiatry especially, we're looking for people and how they relate when we're giving a tour. Are they aloof disconnected on their phone? Are they, you know, present, engaged? asking good questions, curious about the program. In the interview itself, are they thinking only, like, are they almost disengaged, disinterested?

Or are they curious, you know, present, real, sharing what they're passionate about, right? Yeah, I think I looked at this article from, I think it was Harvard, business review, HBR, and it gave three areas for business interviews. And I was thinking about those areas in terms of the residency interview, because let's face it, I'm also interviewing for myself for next year. And so part of this is just helping me to interview well as I go out into the real world. And the areas came up to be something like this. Everybody wants to know this

when they're interviewing you. What will it be like to work with you? And like you said earlier, they want, if you're being all defended and you're giving these rote, standard, trite answers, the goal is not to not say something wrong anymore. The goal is to say who you really are so they can remember you and know you and get a sense of what it's going to be like to work with the real you. So your answers need to be authentic. And hopefully any good psychiatrist or psychologist is going to be able to read if you are hiding or faking or a little nervous about proceeding with a true accurate answer. They also want to know things like what's your interest in the specialty. And they already know their specialty. So they don't need you to give, you know, basic information

about what the specialty is. They want to know what's your personal interest in it. What do you want to do? What do you see yourself doing? It's okay if you change your mind a few years from now. The point here is to be seen as an individual that has highly developed interest in something that makes you stand out from the crowd. And I believe you and I talk. And I believe you and I talked about this offline at some point where we said, you know, if you have one area that you know that's beyond what a fourth year student should know that goes a little deeper, you want to talk about that, you want to include that. And again, it's okay if you don't end up pursuing that as your subspecialty. It just is nice to stand out to show that you've done more than the average

person who is applying to this. Ultimately, they want to know, are you going to be a good fit for the program in that sense of what it would be like to work with you because your average Tuesday on call is going to be tough. It's going to be difficult. And what is it going to be like to work with you at 2 p.m. on a Tuesday? I want to come back to the values because we talked about values. And if you have that list, these are the things that I aspire towards. If you lead with that and then say, hey, you know, when I was in medical school, I did this research. And my values are that someday I want to be this you know, psychiatrist who's blah, blah, blah, blah, blah, right? And these are my values.

These are the things that I really aspire towards. And, you know, I think in some way I was able to get a glimpse of that when I was on this rotation or when I worked on this project or, you know, learning this bit of information. And I want to continue to aspire towards that. You know, so it's like, it's like you're tying in the narrative with like, here's the things that I value and here's the things that demonstrate that I value these things. I did one thing, and I stole this from somewhere, but unfortunately I don't remember where I got it. And I've used it to teach some med students how to prepare for interviews, and I've gotten feedback that they found it helpful.

And the idea of it is that as you're going through medical school in third and fourth year, you're encountering patients. And, you know, there's this old axiom that you learn best during those years through the patients. And so I started keeping a list of patient encounters that were particularly impactful to me. And when it came to be interview season, I had six that stood out that were related in some way to psychiatry. And I took those six and I kind of bullet pointed them so that I could summarize them in about two minutes, about 120 seconds, each one. and I then practiced telling those stories slightly differently as answers to different questions or as examples of an answer to different questions. And so I can still remember some of them to this day. I've tried to find my list on my phone, but I can't actually find it anymore. But what that did was it showed the values in a narrative form.

So it kind of showed what was important to me. Like, let's say you get the question of, you know, what's it like to deal with an attending when you have conflict? Everybody's going to ask some sort of conflict question, whether it's with your peers or with the superior or with a patient or whatever. And so, you know, and I had this, I had a couple stories that I could tell as answers, as examples to answers to that question. And mine involved, you know, this attending, like walking out of the room when I was a third year med student and me having to deal with the damage that this person unfortunately did in terms of. of how they related to the patient. And it expressed this value of deep connection, a value of not giving up,

some tenacity there, but it reflected a certain piece of me in a narrative form. So I didn't have to say my value is this. I just told the story. And I think it sold the point pretty well. Yeah, I'm reflecting back as you talk about that for our interview.

And like, I'm really trying to think what stood out. There were two things. One, that you desired to start a podcast and that you had training in that. And I think once you figured out that I was interested in starting a podcast, you kind of ripped on that narrative for a while. And you educated me. I think I told you what microphones to buy if you wanted to start one. These are the microphones that you told me to buy. Interestingly, we actually, the first podcast episode I ever recorded was with Neil. And I forgot to press start. So we recorded in our podcast, which... And it was hot in that room. Oh, it was, and we were both nervous. We were both like so anxious, or at least I was. Well, yeah, I was two years out

from being ready to host or anything. Yeah. Things I spared you as an audience. You also threw me off in the interview, because you brought up something about something that I said, you literally said something like, well, that's because of your trauma. And I said, I don't have trauma. And you said, Neil, you just gave two examples. And I had, honestly, there were gaps still in my story. And I still remember that to this day. Like, holy crap, I hadn't even thought about like my past in those terms. And there you are bringing it up. And had I not practiced in a way that I could respond to things that, there are questions that are going to ask that you cannot be prepared for. And the whole point of that is stress reaction and stuff like that. Now, I don't think that's what you were doing. You were

literally just educating me kind of off the cuff. And at the time, I just had not thought about certain experiences that I'd been through as traumatic. Gosh, I don't even remember asking you. The way that you told that story right now, it seems a little bit like it was kind of jarring for me to say that to you. It was jarring. I mean, I had this incident where a gun was pulled on me earlier in my life, and I had this incident where I was attacked in a separate incident. And I probably alluded to that those as answers to tough times in the past or something that you had asked. And that it went to there. Okay.

Wow. And so what was your experience of me and how I asked that or how I said it? I thought it was compassionate, first of all, because of the way you said it. And then, but it was also educational. but it didn't make me feel guilty for not having realized that. It just seemed natural. Like, it seemed like something a supervisor would do. And I left the interview with Loma Linda thinking,

well, that if that's what it's like to be supervised, I would be okay being there. Oh, that's good. That's good. And by the way, I told those stories multiple times in other places as examples to answer questions because, and how did people respond to it? Well, no one else responded negatively. They just took it as, oh, those are good answers.

But you added something. So here's an interesting point. You added something that was insightful. You were teaching me in the moment in a non-harmful, non-shameful way, and I value learning. So the fact that you could teach me in the moment stood out to me as something that I would one in a program. Yeah. Interesting.

Well, I think it worked out. The other early impression I had of you was that you were very, like, I like people who are excited about life. And you came in and you were like, I want to learn. I want to grow. I want to like, you know, expand my knowledge. And that was very attractive to me as an interviewee or an interviewer. and as a...

What's interesting, you bring it up that way. Hopefully, I said it better than in those terms directly, but that's exactly the other two categories that came up on this Harvard article, which was every interviewer wants to know, in addition to what it would be like to work with you, can you learn, and do you take initiative? And so those are the three big categories.

And the can you learn, what they're looking for is, do you have a realistic understanding of the specialty? And again, not an understanding that someone who's already graduated the program would have. But have you taken the time to understand what it really looks like in the day-to-day average work? You know, hopefully you're not spending time talking too much about money because that stuff's already assumed that you know kind of that. But do you have the understanding of average, you know, what the average lifestyle looks like in that specialty? If you have any red flags from your past, the spoken or unspoken question is, do you have reasons or do you have corrections from those red flags?

Like, have you dealt with that? Are you a learning person that has, there's no perfect applicant, there's no perfect program. Have you shifted something as a result of something going wrong in your past? And they may not ask that directly. Of course, they might. but everyone wants to know and is waiting for you to tell them that you have learned or changed or grown from that experience. And in the final category, do you take initiative?

You know, it is so much more exciting to hear, you know, if you've built something, if you've repaired something, if you've improved something, and to give examples of that, rather than just say, you know, I'm a take charge kind of person or I'll get things done, just to have an example that you've done that because those, you know, everybody wants people in their programs that are going to get the daily work done and hopefully help leave some part of the program better than when they got there. Yeah, those are really, those are good things. I also want to touch on, like, how you interview the program.

And I think, you know, there's going to be times where people ask you, do you have any questions? and you should have some questions. You always should have questions. If anything you prepare the day before, be ready for that question. Do you have any questions? And from that, I think you need to understand your values. For example, if one of your values

is to do psychotherapy, to be partially a psychopharmacologist and also equipped to do good psychotherapy, one of your questions should be you know what is the psychotherapy training like and um you know how is that taught how what is the what is the supervision like um and so i'll have i'll have people who read probably that i'm into psychotherapy that i teach the psychotherapy here it's on my bio and they'll so they'll say to me in the interview that they are really interested in psychotherapy and then i'll say oh how do you evaluate a program if they're good at psychotherapy.

And I'm asking this for two reasons. One, I'm asking it because I want them to have thought through how they're going to evaluate us as being strong in psychotherapy, so they choose us. But I also want to see their thought process on how they're thinking about how they're going to learn this, how they're going to learn this skill, which in some programs that are very, you know, psychopharm-based,

there's not a lot of psychotherapy. There are those programs out there. And I'm also wanting to know in the midst of that, they've told me that they're interested in psychotherapy. So I'm going to follow up with, oh, tell me about your interest. What's got you interested in that? Have you read any books? Have you, you know, spend any time watching someone do psychotherapy or, you know, or the like?

And some people, it is like crickets. It's like, oh, shoot. No, it's something that I've just started to get interested in as I'm on the trail. And that's okay. But there's been a couple people who have been like, yeah, I've read Yallum's The Gift of Therapy, or I've read, you know, if you're into psychotherapy, you should probably read that. Or I've read, you know, some of Bessel van der Kalk's work. Or I've thought about this.

Or, you know, I got exposed to some cognitive behavioral therapy. And, you know, I've tried to practice that with my patients. Or I've read William Miller's motivational interviewing. and I've tried to do that on every patient I've had with addiction. So once you know what you're interested in, once you know what your values are, you can start to think about the questions that you would ask to basically find out if that program aligns with your values.

And the other biggest thing I think to think about when you interview on the interview trail is what is the culture like and what are some of the markers of a good culture? a healthy culture. Here's what I would look for. And then maybe you can share what you think about this. When you go out to the dinner before,

how many residents show up, how do the residents interact with each other? Do the residents still have excitement for their program? Or are they kind of like, you know, it's a little bit more sober-minded, right? how do the residents treat each other or interact when you see them at like lunch the following day? Yeah, I look for two things. I want them to be realistic and passionate.

And if they can be both, then I get the sense that they're not holding back or hiding anything. One thing you can do is just look in a general sense of the energy level of the residents. Now, in your harder programs with higher call volume, the residents, especially the first and second years, are going to be tired. And I don't know that I would hold that against them because that may be a great clinical program that just has higher call volume. Of course, if you just want the easiest life possible

than residency, that those programs may not be for you, but you also need to think about the total number of experiences those residents get exposed to because you're going to primarily repeat the patterns in your clinical practice that you learn during residency. So I look at the general sense of resident energy level, how willing they are to share the bad, but still be passionate about the good. And then I don't have as many concerns that they're hiding something. I do get a sense I know it.

So if someone asked me that at Loma Linda, I say, oh, yeah, we have one big area of weakness. And that is we don't have quite as much clinical research as I would like. but then I move on to show them, but we have all these other things. And so the only person that would be a true bad fit for Loma Linda might be the person who's wanting to come in there and work with attendings that have robust research programs that have been going on for years that are well funded. But if they're willing to start some new research program, we have the support for that. We would love those kinds of applicants. So even in something like the weakness, there's areas of opportunity, and you could look for those. I also look for a sense of resident cohesiveness

because in my limited experience so far, the residents that do well, in some ways you can predict resident success based on their class cohesiveness. Now, you have no control over who you match with, but you do have the ability to take a look briefly at the residents who show up for the interviews or who are around and you can see

do they like each other or not? Because if you go into a program where there's less cohesiveness and you are more of a team player or you're more of a leader, then you're going to be really, I mean, unless you're one that's going to just do it solo, you're going to be joining into those dynamics that already exist. And so it's nice to know what you're getting into. Yeah, that's some good stuff. And I think, like, our program here at Loma Linda,

it is a little bit more of probably higher demand, more intense. And we're pretty open with that because we, you know, we were looking for good fits. And if you're going to work hard here, the first two years are tough. And I think that that's hard for some people to understand. Like there's some therapists who supervise residents. And for example, they may not quite understand the level of fatigue that a second year might be coming in with during like a teaching seminar.

And there might, it's hard, it's hard to know that not that the hours are like incredibly crazy, but the volume and the amount of patients and the acuity of the patients, the first two years of psychiatry residency is like you're seeing the sickest of the sick had a tertiary care. center. And you're seeing a lot of them. Yeah, but and even in that, that's the negative side of it, but the positive side of it that you can see your last two years is that when, if you go to every clinical experience that Loma Linda offers just at our institution, you will get through 10 or 11, I think it was 10 physical locations and 11 different types of patients that you would get to work with in four years. And I mean, you know, not. every program can offer quite that variety. And so every program will have strengths, every program will have weaknesses,

and you really want to try and get a sense of what is unique about that program, what separates it from others. And, you know, again, there's no perfect way to analyze it. You only have so much time. But it's really helpful if when you get done with interviews, you can reflect on this and kind of pre-rank the program as soon as you can. I would write down some specifics. in my phone as I was sitting in the plane on the way back.

And I would also then reflect upon myself and the answers that I had given and see if there's anything that I wanted to change. There's always something that I wish I said that I hadn't. And there's always something that I stuck out that I was kind of proud of that I had said and answered in a certain way. And so, you know, I would kind of change it from time to time. And you're going to be tired by the end of the interview season no matter what you do. And at some point you might feel like I don't care anymore.

or just put me wherever you want me, rank me wherever. But, you know, as you go through it, you can make changes and even improve your ability to interview as you go along. And those little notes, just the little, even if it's three-word phrases, about the program that you liked or you didn't like, will be very important to look back on when you're trying to decide which program am I going to put number four versus number three. You know, I know I said our demands here are tough, but I really feel like the intellectual property you leave with is very valuable.

And so I want to emphasize that even if you're putting in a lot of hours, and sometimes you'll get disillusioned by working as hard as you do in psychiatry residency across the board, I think it's tough. Residency is tough. coming back to this is intellectual property it's impossible to gain it if you don't put in the time if you don't have the supervision the excellent supervision and and it's valuable it's incredibly valuable the the four years of medical school the four years of residency those it's intellectual property and you will take that for the rest of your life and it will help you serve humanity and help people not die. That's what we're in the business

of helping people not die. So thinking about that and thinking about your values and what type of person you want to be coming out of residency and looking at some of the fourth years and getting to know them, getting to know their stories,

what they're into, you know? So when you're on the interview trail, when you're at dinner, get to know them as people. You know, wait, what are you guys into? What do you feel like, how have you changed as a person from the first day you stepped into residency to now? How have you grown as a person?

Do you feel like you, like, how, do you feel like you've learned things that makes you see the world differently? And what are those things? Be curious about those things. And, Neil, I really like, Dr. Christopher, I really like how you specifically emphasize, you know, writing some notes because interviews will start to blur together. I would write notes about the people that interviewed you as well. And some of the things that you discussed, especially if you plan on writing thank you letters,

all of that usually gets put into the big file, which is your file that a presidency will have on you. So, you know, write down some specifics, write down some things that you were grateful for, and keep a record, keep a record of your experiences. Because after you go on like 10 or 12 or 15 interviews, they all start to. to kind of blur together. And you really left with a gut feeling at the end of the day. At least that's how it was for me. Being a P and not a J,

I didn't want to make my decision until like the night before. You know, I had to put in my rank order list. You're a J. So you probably wanted to make your decision as soon as you could. Yes. I like to leave my options open. And it really comes down to the interactions, the way that you felt coming out, for me at least,

of the program, the culture that you witnessed. Yes, yeah. Any final thoughts that you have? No, when you're interviewing for this kind of program, it does go both ways. They're interviewing you. They want to know those things we talked about. And you want to know you're interviewing them. You want to know some things about them. And I think that the ideas we've talked about here will get you on a good start towards whether you're interviewing for residency or another degree or for your career. obviously other things come into play if you're interviewing for your career. You know, the lifestyle issues do become more, you know, important at that point because

you're probably going to have this job for minimum of two years and maybe 10 to 15. And so at that point, other issues do come into play. But I think this will get you on a great start for perhaps looking at the interview in a different way than just, you know, doing well or saying, not saying the wrong answer. One final thing I want to emphasize is if you're like listening to this and you're an N.P. or a PA, you know, and you didn't have residency, right? And you're like, well, how does this apply to me? And what I would say is you're interviewing the places that you would work at to find the best supervisors.

that you can basically do a residency over the next four years, you know, because, you know, there's just no way that after medical school, for example, you can start and just practice, right? And so in my mind, it's paramount to interview to find the best supervisor. And I would say far above, that's more important than the pay. And I would emphasize that especially for even people leaving, residency. For me, when I left, I was looking, I decided to stay at Loma Linda largely so that I could be continually mentored by Dr. Tarr, by Dr. Pro, by, you know, Dr. Murdoch, Dr. Lee, all of the doctors here

that I really, really value and appreciate, Dr. Osorio, you know, doctor and speaking, I could, there's a list of them. I can, I can, like, ask these people questions all the time. And I do. And so thinking about your interview, if this is beyond, you know, residency for you as like, you're thinking through, am I going to learn from these people? Are these people I aspire to be more like in the future? And keeping that in mind as you go about and base your values on those things. Yeah, I think that's a good point to end on, is you're joining a community, whether it's for training or for practice. You are joining a community. Is this community going to be able to allow my values to be expressed and pursued further? Or is this community going to limit my values and not allow me to flourish and become the kind of person that I'm moving towards? Excellent. Thank you so much, Dr. Neal Christopher, for coming on.

Check out his podcast. I'll put a link in the show notes. And I will put his PowerPoint. Can I put your PowerPoint in my resource library? Yes. Okay, I'll put that in the research library. He's giving a lecture on this to some medical students soon, so I'll put that in there. And thank you so much for checking in.

Let me know if you have any thoughts. Hope you're having a great day. Take care.