Program Director’s Corner – September 2018
Defining Noncognitive Domains During the Interview Process
Dr. Debra Simmons
debra.simmons@hsc.utah.edu
Program Director, Endocrinology and Metabolism
University of Utah
Dear Fellow Program Directors and Administrators:
Another interview season is upon us and I would like to share some of my thoughts.
Although busy, it is an exciting time when we get to meet with many of our future endocrinology colleagues. I enjoy talking with them about how they became interested in endocrinology and what they plan to do with their career. I am impressed by their desire to contribute to the field and help the many people with endocrine diseases. Many seem genuinely motivated by compassion for people suffering from our common to rare diseases and have ideas about how to help. Despite the importance of selection of candidates who have the best fit for our individual training program, there is a paucity of data that could guide us. Interestingly, we also do not have an agreed upon definition of excellence in clinical care which should be the cornerstone of our training programs. Dr. Baum has an excellent article (1) on excellence in clinical endocrinology that should be required reading for all of us! He thoughtfully proposes a definition for our specialty. He believes that key aspects of clinical excellence in endocrinology include the following: the ability to work in teams, communication and interpersonal skills, skillful negotiation of the health care system, and a strong knowledge base and scholarly approach. He calls on us as program directors to foster the development of skills necessary to deliver excellent clinical care in both our trainees and our faculty. As the ACGME has asked us to review and revise our milestones, it is an opportunity for us to consider how to best do this.
The standardized letter of recommendation for fellowship applicants endorsed by the Alliance of Academic Internal Medicine (AAIM) addresses the ability to work in teams, communication and interpersonal skills, knowledge base and scholarly activity as measured in the residency program (2). It is a starting place for us to assess the potential abilities of our applicants in the skills Dr. Baum proposes are necessary for clinical excellence. Skillful negotiation of the health care system and a scholarly approach to clinical care are not directly addressed by the current letter. The interview selection committee for my program at the University of Utah reviews all available information in the standard ERAS application. We give priority to those who engage in scholarly activity but other than attention to negative comments, do not uniformly assess for these skills either by the interview selection committee or by the interviewers.
Bosselet and colleagues (3) developed a validated customizable tool to score resident and fellow applicants for selection to be interviewed and for the interview itself in the ERAS application system. Their “ERAS Application Scoring Tool-Interview Scoring Tool” method correlated well with traditional ranking methodology at all five participating institutions. Using the tool would allow for standardization across programs and could potentially be used to compare outcomes of fellowship training. The interview tool is comprised of more subjective components including fit for the program, insight and interpersonal skills.
Tatem and colleagues (4) developed a behavioral-based interview (BBI) method to better assess the noncognitive aspects of trainees at their institution for pulmonary and critical care medicine fellowship. They plan to evaluate how this change in their interview process relates to outcomes for their fellows. They also suggest that their standardized BBI method could be adapted for use by other training programs.
Standardized interviews have also been explored in the surgical field and similarly seek to better assess noncognitive aspects in addition to knowledge and technical skills. Emotional intelligence (EI) was found to be associated with job satisfaction (5) and burnout (6) at one residency program. High EI was associated with enjoying the job and low burnout. Lin and colleagues (7) at a different training program determined that EI could not be reliably assessed in the interview. Gardner and Dunkin (8) describe the process that Baylor College of Medicine Surgery Program used to develop an evidence-based selection system to select and rank applicants. Situational judgment tests and personality profiles were used for their on-line pre-interview selection process. Wow! How innovative is that? That information was also used in the final ranking scores. In addition, Gardner and colleagues (9) developed a training program for a structured interview by faculty that resulted in improved assessment of competency and increased interrater agreement.
These are ideas that may be good for us to consider. Including a standardized assessment of noncognitive domains may be helpful for us to incorporate into our interviews and our training programs. This could be informative for work-life balance, avoidance of burnout as well as for leadership development. Many of us participated in the survey Dr. True and colleagues (10) developed about the need for leadership training in endocrinology training programs. The results clearly indicated that both the program directors and trainees believe that there is a need.
My final thoughts relate to our matching the fit of the program to the needs of the trainee. Two articles seem to address this although indirectly (11, 12). They are written for fellowship candidates trying to help them understand the process and how to assess the fit of a program with their needs. Kudos to the GI and Pulmonary/Critical Care communities for doing this! Both articles illuminate the process in very practical terms. It is informative to flip our thoughts as program directors to mirror finding a good fit from the program view. Articulating what we want is a first step for each program.
What would I like for us to do? I would like for everyone to read the two articles on excellence in endocrinology and the need for leadership training. Please think about how we could better define some of the noncognitive domains important for success as a trainee and subsequent practicing endocrinologist. Interacting with the fellow candidates during their interviews could give us insights into what they might need and help us continue to train the next generation of excellent endocrinologists.
References
1) Baum HBA. Clinical Excellence in Endocrinology. J Clin Endocrinol Metab. 2018
May 3. doi: 10.1210/jc.2018-00916. [Epub ahead of print] PubMed PMID: 29733361.
2) Alweis R, Collichio F, Milne CK, Dalal B, Williams CM, Sulistio MS, Roth TK,
Muchmore EA. Guidelines for a Standardized Fellowship Letter of Recommendation.
Am J Med. 2017 May;130(5):606-611. doi: 10.1016/j.amjmed.2017.01.017. Epub 2017
Feb 9. PubMed PMID: 28189466.
3) Bosslet GT, Carlos WG 3rd, Tybor DJ, McCallister J, Huebert C, Henderson A,
Miles MC, Twigg H 3rd, Sears CR, Brown C, Farber MO, Lahm T, Buckley JD.
Multicenter Validation of a Customizable Scoring Tool for Selection of Trainees
for a Residency or Fellowship Program. The EAST-IST Study. Ann Am Thorac Soc.
2017 Apr;14(4):517-523. doi: 10.1513/AnnalsATS.201611-938OC. PubMed PMID:
28362524.
4) Tatem G, Kokas M, Smith CL, DiGiovine B. A Feasibility Assessment of
Behavioral-based Interviewing to Improve Candidate Selection for a Pulmonary and
Critical Care Medicine Fellowship Program. Ann Am Thorac Soc. 2017
Apr;14(4):576-583. doi: 10.1513/AnnalsATS.201611-940OC. PubMed PMID: 28306323.
5) Hollis RH, Theiss LM, Gullick AA, Richman JS, Morris MS, Grams JM, Porterfield
JR, Chu DI. Emotional intelligence in surgery is associated with resident job
satisfaction. J Surg Res. 2017 Mar;209:178-183. doi: 10.1016/j.jss.2016.10.015.
Epub 2016 Oct 20. PubMed PMID: 28032557.
6) Cofer KD, Hollis RH, Goss L, Morris MS, Porterfield JR, Chu DI. Burnout is
Associated With Emotional Intelligence but not Traditional Job Performance
Measurements in Surgical Residents. J Surg Educ. 2018 Feb 23. pii:
S1931-7204(17)30516-0. doi: 10.1016/j.jsurg.2018.01.021. [Epub ahead of print]
PubMed PMID: 29483035.
7) Lin DT, Kannappan A, Lau JN. The assessment of emotional intelligence among
candidates interviewing for general surgery residency. J Surg Educ. 2013
Jul-Aug;70(4):514-21. doi: 10.1016/j.jsurg.2013.03.010. Epub 2013 Apr 30. PubMed
PMID: 23725940.
8) Gardner AK, D’Onofrio BC, Dunkin BJ. Can We Get Faculty Interviewers on the
Same Page? An Examination of a Structured Interview Course for Surgeons. J Surg
Educ. 2018 Jan – Feb;75(1):72-77. doi: 10.1016/j.jsurg.2017.06.006. Epub 2017 Jul
29. PubMed PMID: 28625496.
9) Gardner AK, D’Onofrio BC, Dunkin BJ. Can We Get Faculty Interviewers on the
Same Page? An Examination of a Structured Interview Course for Surgeons. J Surg
Educ. 2018 Jan – Feb;75(1):72-77. doi: 10.1016/j.jsurg.2017.06.006. Epub 2017 Jul
29. PubMed PMID: 28625496.
10) True MW, Folaron I, Wardian JL, Colburn JA, Sauerwein TJ, Beckman DJ,
Kluesner JK, Tate JM, Graybill SD, Davis RP, Paulus AO, Carlsen DR, Lewi JE.
Leadership Training in Endocrinology Fellowship? A Survey of Program Directors
and Recent Graduates. J Endocr Soc. 2017 Feb 9;1(3):174-185. doi:
10.1210/js.2016-1062. eCollection 2017 Mar 1. PubMed PMID: 29264475; PubMed
Central PMCID: PMC5689151.
11) Madanick RD, Yoon SS, Abraham R. Selecting a fellowship in gastroenterology.
Gastroenterology. 2012 May;142(5):1050-4. doi: 10.1053/j.gastro.2012.03.028. Epub
2012 Mar 21. PubMed PMID: 22446474.
12) Bosslet GT, Burkart KM, Miles MC, Lenz PH, Huebert CA, McCallister JW.
Preparing for Fellowship in Internal Medicine. Steps for Success with a Focus on
Pulmonary and/or Critical Care Programs. Ann Am Thorac Soc. 2015
Apr;12(4):567-73. doi: 10.1513/AnnalsATS.201501-033AS. PubMed PMID: 25742296.