Pharmacy Residency Applications and Pre-Interview Rankings

The larger residency programs often receive hundreds of applications each year for a handful of residency positions.  Before PhORCAS, large amounts of data would need to be transferred from paper applications to spreadsheets allowing for a fair and consistent comparison of candidates.  As the number of applicants has grown and because the applicant numbers are expected to continue growing, more programs are turning to internal rankings using data pulled from PhORCAS.  A recent study published in the American Journal of Health-System Pharmacists describes one program's system for determining which applicants to invite for an on-site interview.  Prior to the analysis, they used 13 different characteristics.  After evaluating which factors were most likely to predict whether an applicant received an on-site interview, they removed duplicate factors and came up with 7 applicant characteristics which are starred below:

• Work experience pertaining to pharmacy*
• Professional association involvement*
• Types of rotation experiences*
• Publications*
• Presentations*
• Certifications and skills attained*
• Experience with research
• Grades*
• Recommendation letters
• Service to the community
• Awards and scholarships
• Letter of interest
• Leadership experience

Although letters of recommendation had the highest odds ratio of all of the characteristics (2.04), the 95% confidence interval suggests high variability with the predictability of this characteristic (0.79 - 5.27). The authors noted that most candidates score highly in this area making it a less valuable predictor of whether a student will be extended an offer to interview.

Grade point average was evaluated as a continuous variable in this model.  The applicability of the model to evaluating candidates without a GPA (ex. students from Roseman University) were not evaluated.  They noted that in the future, GPA could instead be used as a dichotomous variable (ex. yes or no to GPA above a certain cutoff) since students with a GPA below 3.0 were not extended an offer to interview.  

The authors felt that this process would be generalizable to other institutions but note that specific factors may vary by institution and that characteristics were not evaluated against PGY1 pharmacy practice residency performance.

Ensor CR, Walker CL, Rider SK, Clemente EU, Ashby DM, Shermock KM. Streamlining the process for initial review of pharmacy residency applications:  An analytic approach. Am J Health Syst Pharm. 2013 Oct 1; 70(19):1670-5.

Rank Order Decisions

As a reminder, rank order lists are due to the National Matching Service (NMS) or "The Match" are due on Friday, March 8th and Match results will be released on Friday, March 22nd!

Deciding which program to rank can be even more agonizing than deciding where to apply.  Programs that looked good "on paper" may not be as impressive in person.  Alternatively, a program which wasn't initially the highest on your list of considerations may now have some big selling points after you have visited the site and met with staff .  You may be creating lists of "pros" and "cons" for each interview site and also weighing just how important each "pro" and "con" is to you.

Here are a few basic things to consider:
1. Let your rank order reflect your short-term and long-term goals but don't forget to consider what your training will be like in the interim.  After you finish your PGY1 residency, what do you want to do next?  If you perform well as a resident, you may have a PGY2 position or job offer at the site if positions are available.  You may be weighing objective factors such as opportunities at a site (training stucture and opportunities) against the intangible factors (organizational philosophy or how much you felt you "fit"at a site).  My recommendation is to ultimately go with the "gut instinct" because if you are self-motivated, you may be able to create some learning opportunities in your residency.  Just remember:

2. DO NOT base your ranking decisions on how much you think the site liked you. Remember, it is against ASHP residency matching rules for either the site or the candidate to overtly share rank order before the match.  Some places are better about playing "poker face" than others.  A few sites may more aggressively court candidates but the larger majority stay silent until Match Day.  Dr. Smith and I have many, many stories of candidates who didn't rank a site or prioritize them higher and then were very surprised / disappointed to learn later on how much the site wanted them.

3. Conversely, if you encountered some red flags during an interview, think about the context.  Were there extenuating circumstances on your interview day?  For instance, a local hospital had a Joint Commission survey during their major interview week so staff there were understandably pulled in many directions during that week.  Was the negative interaction with a specific person at the site or did you sense it was the overwhelming culture?  When I was interviewing for residencies, I was put off by the attitude of a current resident at the time.  I finally decided I liked the site as a whole and am so glad I matched at a site where the overwhelming majority of pharmacists were very positive and welcoming.  You do have to spent at least 40 hours a week at site so were these red flags a deal-breaker?  How much are you willing to risk not matching at any site if you decide not to rank an institution? 

Best of luck with a difficult decision!  Please keep Dr. Smith and I informed about your results so we can congratulate your success or strategize during the scramble.

What will you be asking during interviews?

Most candidates will go through the process leaving a favorable or neutral impression, but occasionally candidates come up with questions which are perceived very negatively by the residency program.  They are negative because they are judgemental or delve into privacy issues.  Other questions which leave a negative impression are those which leave the residency preceptors with an impression that the candidate doesn't want to work hard or that the candidate is "high maintenance."  Here are some examples of questions which are best left out of your interview.

1. What problem areas were identified during the last ASHP accreditation visit?  It's fine to ask about what the program is hoping to improve upon; it is not okay to try to identify "dings" from accrediting bodies.
2. Why was so-and-so ex-resident let go from this residency program? Personnel issues are private as all pharmacy residents are considered employees.  There is really not a good way to ask about this topic. 
3. Why did so-and-so ex-resident quit this residency program? See #2 above.
4. Why did this program have an unmatched position last year (or the year before, etc.)? Because the matching process starts with the candidate and not the program, there are many reasons the program may have an unmatched position which may have nothing to do with the program's quality.  Sometimes the highly competitive programs are all going after a common pool of candidates, for example. Use other questions to try to assess the quality of the program but keep in mind that you should also be thinking about "fit."
5. What time would I be allowed to leave for the day as a pharmacy resident? This question implies that there is something in this resident's life which is a greater priority than the residency.  Candidates indeed have practicality concerns when it comes to childcare and similar responsibilities, but consider instead asking the current residents about the hours of their "typical day."
6. How did I do on the interview? Even if you have done well, this will leave a negative impression because it makes it seem like you are needy for constant feedback.  Asking this question is not worth the risk because you can't change how you did and even if they think you are a good fit, another candidate may outrank you.
7. Where will you rank me or how many candidates will you be ranking? This relates to the question above.  The "how many candidates" question is a problem because there may be candidates who will not be ranked and answering the question may reveal which candidates fall into that category.
8. How many candidates were interviewed? The temptation to try to calculate where you will end up in the match is very high in this process. It is far more valuable to focus your efforts on asking detailed questions about the residency as that will help sell your committment to finding the best residency for you vs. revealing your anxiety about "getting something" in the end.