Thursday, September 19, 2013

Nice. Hardworking. Smart.

The electronic applications for residency programs just opened up on Sunday. Four plus years of medical school and lifetime accomplishments all nestled inside of one click of a mouse. Medical students all over the country have been sending off emails that escalate in their urgency to faculty who've agreed to write letters of recommendation and the residency program directors who will be reading them. I happen to wear both of those hats.

And so. Over the next week or two, students finalize this really important profile of who they are. They cross their fingers hoping that they crossed all of their t's enough to get the attention of the right program in the right city offering the right training in the right specialty. For them, that is. And it's funny because what many of them forget is that we, the program directors, are doing the same thing in a way. Hoping our programs appears attractive to the most attractive applicants. Attractive in terms of academic profile, that is.

All of this--these electronic applications, the interviews that follow, and the subsequent mind-wracking that ensues as everyone tries to finalize a decision ultimately leads to that big day where medical students all over the country find out their temporary destiny. But long before the tears and hugs and scraps of torn match day envelopes is all of this. Students putting their best face forward on this computerized application and us, the programs, doing our best to get a glimpse of who these people are based upon what we find when we click on their names.

How apropos that it all leads up to Match Day, isn't it? I mean, really, it is considering all of this is a bit like "" if you ask me. One person creates this shiny, pretty profile on line complete with their most cheerful and I'm-so-super-nice looking snapshot so that some other person will look at it and say, "Hey. I'd like to meet that person." That is, after learning that in addition to going spelunking on weekends they also won the gluten-free cake baking contest for the entire region last year. Or something or other.

And we, the programs, tidy up our websites with chummy photographs of our trainees plastered everywhere. Their eyes are earnest during bedside teaching and then on the handful of candid shots, the esprit de corps is so palpable that any student viewing it feels a yearning in their soul to belong to our group.

And really, isn't that a lot like

And let's be clear. I see nothing wrong with I know several people who have met awesome mates there and have even found a spouse. Yep. But they will all tell you -- just like we who open those ERAS (electronic residency application service) files will -- that sometimes the profile doesn't quite match up with the person. Good, bad, or indifferent.

So check it. I can't speak for what somebody looks for specifically on I can't. I'm not fully certain if there are a set of rules for how you can know if it's going to be eHarmony or not, man. Surely every person is different and they want different things just as every residency program or applicant varies in what they want. But you know? There are some things that are fairly universal that no one seems to talk about. And, for me, this is what I'm always sifting through the application to find. Then, during the interview, I try to confirm that impression.


So what is it, you ask? I'll tell you. I believe that the very best applicants--no matter WHAT the specialty they have chosen--meet this criteria on most days:

  1. Nice.
  2. Hardworking.
  3. Smart.
In that order.

I am NOT kidding. Literally, I have a little scrap of paper where I create a score for myself to see if the person is nice, hardworking and smart. Then, when I meet them, I try my best to see if, on most days, it's in that order. And if it is? Eureka. But even if it isn't, all three qualities are imperative. And when they aren't? That is, when ALL THREE of those qualities are not evident to me from the application and/or the interview? It's a no for me.

Not. Even. Kidding.

Let's look at this more closely. Let's say an applicant got straight A's. Let's say they scored high on the boards and made honor society, too. But then, when you read the letters, you see that they're all nondescript and the personal statement is bland. You meet them and they sit in front of you smugly or come across as bored and disconnected. This applicant might be smart. And I'd go so far as to say that they are also hardworking since they achieved such a great academic record. But nice? That could be debatable. Really.

Then there's the person who is super-smart and mostly nice. But lazy. And that? That's a horrible combination because you get tricked. By the time you realize they're lazy, it's too late. And laziness is really, really hard to remediate. Matter of fact, it could border on impossible. I think of "hardworking" as kind of synonymous with "professionalism" in the medical field. It's hard work to uphold our end of the bargain. And what makes a person do that without cutting corners is professionalism.

Lastly, there's the sweet-as-pie person who works their behind off. And, okay, just maybe they aren't the sharpest crayon in the box. But honestly? Of all of the combinations I've listed (outside of the preferred triple threat) I'd take this combination over the others. Yes. I'll take nice-and-hardworking over hardworking-and-smart-but-not-nice or nice-and-smart-but-lazy any day of the week.  Because at least with hard work the not-super-smart part can get better as far as medical knowledge goes. And sure. I'll admit that to do this--medicine--there is just some amount of intellect required. But I am a firm believer in the "growth mindset" which says that diligence and hard work can make up for what we lack in "natural" ability. Not to mention the fact that not working hard can make innate talents a total waste.


What does this mean concretely for medical students? Simple. Nice people do things outside of just studying. They do things for the greater good of the world and others. They do. They also have a life and hobbies and personal richness to talk about. Because medical school is a selfish pursuit. It's easy to get wrapped up only in yourself and your grades. But what is the point of getting that far and not having your eyes on the real prize? To be a competent and empathic provider? That requires more than books.

It takes a certain amount of "nice" and unselfishness to volunteer somewhere or tutor or participate in anything other than studying. So me? I look for that. I look to see if you worked hard in something, anything other than just sitting on your bum with a laptop. I look to see if you bake cakes or organize students to do good things. I want to know if you learned to speak Spanish or ran a half marathon or painted with water colors. Something. Anything. Not just books. Because being a doctor calls for more than that. It calls for humanism and a scrappiness that can't be found just with studying. That part comes from living.

"Hardworking" people complete things. They finish things they start and if they don't, there's often a reasonable explanation for it that doesn't sound like a typical excuse. They are resilient. They don't crumble under pressure and they keep trying no matter what. And again, they do things outside of just studying. And yes, that can mean a research paper or project. But a lot of times it can mean something else. I look to see if you did something that required planning and time to execute. Because that kind of thing requires hard work. And being a hard worker is a good quality to have in medicine.

And perhaps "smart" is the easiest part. Because to reach the finish line of med school, either you were simply smart or you had a growth mindset and worked SO DAMN HARD that you grew smarter. And we can see that easily on paper. Or from just talking to you.

But the other parts? Those are more nebulous and tricky. 

So listen up med students. And residents applying for fellowships and jobs. This is what we want. We want the triple threat. We are looking for people to come to our residency programs that are:

  1. Nice.
  2. Hardworking.
  3. Smart.

In other words, to use a term coined by one of my favorite students of all time Antoinette Nguyen, we are looking for someone who is a "non-douchebag." 

Yes. That. A non-douchebag. (So all-encompassing, that word.)


Is this what your application says about you? Is this what people would say about you? Are you nice, hardworking and smart--in that order? If you are, you're a great candidate. If you're not, you need to ask yourself why that is and you also need to recognize that this is what OUR PATIENTS want, too.

Our patients. Remember them?


Happy Residency Application Process! May the odds be forever in your (and my) favor.

Bryan O., MD -- who personifies nice, hardworking and smart--in that order.


  1. Ahh, this sounds idyllic. If only IM program directors across the nation had the same viewpoint as you!

  2. I am two and a quarter of the three....won't say which ones!

  3. Just finished the book What Doctors Feel:How Emotions Affect the Practice of Medicine by Danielle Ofri MD. Dr Ofri just spoke at Fox Chase and you and she are sisters from different mothers. You HAVE to read the book and go meet her or have her talk to your fellow educators. She practices at Bellevue Hospital in NYC and loves it as much as you love Grady. You won't be able to put the book down because you will think you wrote it! Medicine is in good hands with the two of you!

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