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Residency Interview 101: Addressing the Elephant in the Room

Let’s be realistic not everyone has the perfect application.  Plenty of people reading this blog are anxiously anticipating how a failed USMLE score, poor clinical evaluation, or low grade might affect their chances in the match. Moreover, I’m sure a lot of you are wondering exactly how this might come up in an interview and what you should be prepared to say if it does.  So, let’s take some time to address the elephant in the room.

Before we go any further, let me just say this
it’s okay!  Plenty of people have matched and went on to have successful medical careers despite having a failed USMLE, low grade, or bad clinical evaluation.  You might not end up with your first choice in the match (or even your first choice specialty), but I promise that your life, and your medical career can survive and thrive in spite of this.

Now, let’s look at some advice on how to handle these issues in your interview.

Most important don’t bring it up in the interview.  

While I’m sure that someone could offer a counterpoint to this, I strongly believe that you should never be the one to bring up any negative aspects of your application.  By the time a program has offered you an interview, they’ve already decided that they would be willing to have you as a resident in their program despite the negative issue in question.  Highlighting these issues unnecessarily prevents your interviewer from seeing all of your other great aspects and hinders your chances of moving forward.  

That being said, you do need to be prepared to address your imperfections in the event that a program director or interviewer brings them up.  So how do you do that?

Don’t be evasive 

Trying to sidestep the issue makes it seem like you’re either hiding something or unable to handle self-assessment. If the issue comes up, you should have a concise and honest answer prepared to explain the poor score, failed exam, or negative evaluation.

Don’t make excuses 

Legitimate personal tragedies aside, nothing is worse than answers like:  I just didn’t study enough; the attending evaluating me had unrealistic expectations; or my school didn’t prepare me for the USMLE well enough.  Answers like these show an inability to accept responsibility and a tendency to externalize blame for negative outcomes neither of which are good qualities in a resident.  

Focus on the positive 

While this is certainly not the best situation to be in, I do think there are positive attributes to be taken away from something like a failed attempt at an NBME or a poor evaluation.  Residency certainly isn’t easy; so learning how to push through adversity and to adjust your performance in response to negative feedback can be great skills to have. Some of the better answers I’ve heard include:

  • For a poor clerkship evaluation  the negative evaluation came as a bit of a surprise, but it showed me that I could respond to criticism by learning from it and improving the way I cared for my patients.
  • For a failed USMLE overall, this experience taught me to push through adversity and helped me figure out the right way to study.  Going forward, I’m confident that these will be great attributes for me as a resident. 

Don’t be too positive 

Recently, when asking an applicant what they learned from the experience of retaking Step 2 CK, they responded that it was the best thing that could have happened to them because it showed them how much they wanted to be a physician and pushed them to make it happen.  While the latter part of that answer was a great response, referring to a failed exam as the best thing that could have happened to you comes off as disingenuous at best.  Make sure you know when enough is enough.

Don’t dwell 

Give an answer and move on.  Just like any topic in an interview, you don’t want to talk so long that the conversation becomes one sided. Provide a concise answer to each question regarding the issue and then allow your interviewer to quickly move on from the subject.


As always, I hope this was helpful. Stay tuned for more advice on interviews and be sure to submit your questions so that they can be included in future blog posts. And if you’re looking for one-to-one residency advisement, we’re here to help.