What I Learned Reading Intern Applications This Year

I have served on intern selection committees for more years than I care to count.  Although there are a lot of similarities year-to-year, there are also some interesting differences.  This is my first year reviewing intern applicants at my current institution, and there is always some variability in applicants from program to program.  Below are some observations I have for readers regarding some things I noticed evaluating intern applications.

Types of letters

One applicant had letters of reference (LOR) from two dermatologists, one radiologist, and one oncologist.  This flies in the face of my advice, and I definitely noticed that they didn’t have an LOR from a ‘core’ discipline specialist.  Maybe their medical skills are weak?  Maybe they didn’t work very hard?  Maybe they didn’t structure their senior year optimally?  Maybe they didn’t realize the importance of a LOR from a core specialist?  Regardless, I took note and marked a possible warning flag for the application.

One applicant had no LOR from their own faculty.  They had LOR from faculty at other institutions, a resident at their institution, and a clinician they had worked with for a short amount of time (<2 weeks).  This is absolutely a red flag for me and suggests this person may be difficult to work with.

What LOR say

I tended to skim the LOR numeric scores just for low scores.  The difference between a top 10% and a top 1% I consider meaningless because of grade inflation.  If an applicant has a score in the bottom 50%, I pause and take note of that.  It doesn’t remove them from consideration, but it definitely makes me wonder if they would be a good fit, particularly when we have so many amazing applicants.

The length of the text in the LOR free form sections I also found meaningful.  Numerous letters had one or two sentences describing the applicant.  Maybe the applicant was wonderful, but it was difficult to believe that without much description.  Relying on the numbers, again, is not my preference.  LOR writers who took the time to describe the applicant provided much stronger letters and increased the likelihood I would rank the applicant highly.

There is a section in the LOR which asks the writer to describe weaknesses of the applicant.  There are some weaknesses which I expect (leadership, teaching, maybe even medical knowledge) and don’t worry too much about.  Other weaknesses I consider to be more problematic (communication, work effort, collegiality).  If someone has communication difficulties, I probably didn’t rank them or ranked them very low.  There are plenty of good applicants who are good at communication.  I would rather take an intern who wasn’t as good with medical knowledge but worked hard and communicated well than a brilliant intern who had difficulty communicating with clients or supervisors.

Letter of intent

I was surprised that a strong opening caught my interest and made me really focus on reading every line of the letter in more detail.  I don’t usually go in for ‘gimmicky’ letters, but I liked some openings quite a lot.  Some examples: “As the next step in my career path, I am seeking a small animal rotating internship,” and “My name is X, and I am applying for a position as a small animal rotating intern.  I bring three major strengths to your veterinary medical team.”

The vast majority of letters were either average or good.  There were only a handful of poor letters, and most of those were due to English language barriers.  The average letters are pretty typical and expected.  They describe what they’re looking for, explain themselves as a candidate, and describe their experiences.  They’re fine.  They just don’t grab my attention or stand out.  The good letters tend to be more evocative, provide examples of experiences that developed their skills, attitudes, or knowledge, and tend to be more expressive and use excellent grammar without using thesaurus words.  It’s a difficult difference to elaborate, so have a look at the good and poor example posts I have posted before.

Curriculum vitae

I found it very difficult for an applicant to stand out on the basis of the CV.  I rarely made notes about the CV for good or ill for an applicant.  The most meaningful things I noted on CVs were officer leadership positions (e.g. president of a club) and different experiences (e.g. being on a collegiate sports team, externships overseas).  Some applicants also had numerous certifications on their CV, which I felt reflected their dedication to education (VBMA, acupuncture, physical therapy, etc.).

Not surprisingly, I applied a lot of the principles I have used before when evaluating intern applicants this year.  I had a handful of interesting reflections (such as the difficulty of having a noteworthy CV).  I hope this reflection is helpful for those applying for internships in the future!

Why Vet School? Why Not Veterinary Nursing?

We have a serious shortage of veterinary nurses in veterinary medicine.  And we have an overabundance of applicants to vet school.  I often wonder why it is that more people are not interested in a career as a veterinary nurse.  Why do so many people apply to vet school (particularly if they go $300k in debt to do so) rather than enjoy a pleasant life doing something that doesn’t require years of schooling and tons of debt- i.e., being a nurse?  I have several theories to share.

Societal expectations.  

In the US, there is generally an expectation that, if you’re middle-class or want to “get ahead”, you will go to college.  The assumption is that college will open doors to future career prospects.  While I always wanted to go to college, when I was growing up, my parents did a good job telling me “Trade schools are a terrific way to train for a profession.  You could work for the post office right out of high school and be quite happy.”  Therefore, I’ve always had the idea that other routes to a career are perfectly viable and- for the right person- far superior to college.  

Plumbers make an average salary in the $50k range- which is about the median income for the US.  And they don’t need to go into hundreds of thousands of dollars into debt to do it.  But I think that many people in the US don’t think about trade school or other alternatives to a happy, successful career.  The default is college.  

If you’re interested in veterinary medicine and go to a traditional college, you usually can’t get a degree in veterinary technology.  Most people major in Biology, Chemistry, Animal Science, etc. which doesn’t necessarily prepare you to do anything other than get more education (i.e. go to vet school).  

Heck, my own BS is in “Veterinary Science”.  What in the world does one do with that degree besides become a veterinarian?  So traditional colleges really only set people up for more education if they are interested in veterinary medicine, rather than provide a practical skill- i.e. being a nurse.

Role Models

So many people decide to become a veterinarian when they are young.  Why a veterinarian and not a veterinary nurse?  I think because they see the veterinarian as the one who heals animals.  But veterinary nurses are tremendously important in the animal healthcare process.  They typically have more contact with the actual animals and spend more time caring for them.  But the young kid with the sick dog doesn’t see that- they only see the vet who supposedly healed their pet.  They don’t see all the incredibly important support staff who were the ones who probably ACTUALLY healed their pet (placed catheter, gave medications, etc.).

Salary

I don’t think many people talk about the salary differential, but I wonder if this is also a source of motivation.  To be fair, we pay veterinary nurses an atrociously low salary for what they know and do.  To me this seems to be a clear failure of capitalism.  

Since there is a shortage, veterinary nurse salaries SHOULD go up.  But they don’t.  I have no idea why.  In universities it’s because the institution-wide policies about qualifications, etc. dictate salary, as opposed to salary being dictated by the actual reality of the job market.  But in private practice, I don’t understand why they don’t offer more money if they have a hard time finding a nurse.

For better or worse, we have a consumer mentality in the US, which leads people to believe they need to make more money to be happy.  So maybe people see the salary nurses make and decide they won’t be happy in life as a result.  I can understand this- making less than the median salary in the US would be a lot less fun than making six figures as a veterinarian.  In my opinion, the solution to this problem is to pay veterinary nurses more.  Maybe that would make it more attractive to people who want to be in veterinary medicine in some capacity.

Leadership

This somewhat goes back to societal expectations.  We have a narrative in the US that the doctor is the “important” person and the nurses are less important.  We tend to ascribe value based on salary, which is messed up.  Everyone has value as a person, and I think veterinary nurses provide at least as much- if not more- value to the patients than the veterinarian.  Nonetheless, I can see people thinking, “I want to be the one telling others what to do rather than being the one told what to do.”

But… do you really?  I often envy the janitor.  They show up, they clean things, they go home.  I worked cleaning the ORs during a summer in college and I loved it.  It was very meditative and I could enter a nice flow state.  Having responsibility in your job is not always sunshine and rainbows.  I sometimes have a fantasy of being a veterinary anesthesia nurse at some foreign institution.  Just show up, take care of patients, and go home?  Sounds nice.  I see a fair number of senior veterinary students who DON’T want to be leaders.  But every veterinarian is a leader.  So there is clearly some disconnect between expectations and reality for some people.

Those are the reasons I can come up with for why we have so many applicants to vet school and not enough veterinary nurses.  What others can you think of?

On-Campus Writing/Career Services

Most universities offer a centralized writing assistance service as well as a career assistance service.  The writing service often helps students with class assignments, but can also be used to help with letters of intent and essays for vet school.  The career assistance can help with CVs and applying for positions such as unpaid experiences (“internships” before you get into vet school).  Usually these services are free.  I think you should absolutely take advantage of them, with a few considerations.

You must plan.  For a letter of intent or essay, you first have to write it.  Once you’ve done that, then you can schedule an appointment to have it reviewed.  Listen to the advice you are given, but you don’t need to follow it.  As with all advice, you should solicit multiple sources of feedback and incorporate what you like and ignore what you don’t like.

For a CV review, you should definitely take any advice with a grain of salt.  Curricula vitae in medicine are VERY different from resumes in other fields.  The most striking differences are that you can have more than one page with a CV (in fact, as many as you want) and there is no need for job descriptions to be included.  Nonetheless, these people have seen hundreds of CVs and can provide some useful guidance about formatting, content, organization, etc.

The on-campus people have seen a LOT of material and can be very valuable in some ways.  BUT, you need to consider any advice you get in the context of veterinary medicine, with which they probably don’t have much experience.  As always, solicit feedback from your mentors.  But the on campus resources may be very helpful.  And they’re free, why NOT reach out to them?

How to be a +1

A foundational concept you NEED to understand is to Aim for Zero.  I encounter so many students who aim to be a +1 and end up being a -1 as a consequence.  At the end of the day, the students I most enjoy working with are the ones who are quietly competent.  The students who ask esoteric questions, who try to chat me up, who stress about their grades, and who try to be more competent than they are are among the worst I work with.

So, if you can avoid being a -1 by aiming for zero, what if you want to be a +1?  Honestly, I would follow the steps in the How to Be Successful series.  But I will outline them here, in order.

#1 – Show up.  You HAVE to be there when you’re supposed to be.  Ideally, you should arrive before and leave after everyone else.  As a general rule, the students should arrive before the interns who should arrive before the residents who should arrive before the faculty.  And inverted at the end of the day.  I would say fully 70% of students don’t even Show Up so, if you do, that is a big step towards becoming a +1.

#2 – Be humble.  Arrogance prevents you from having a growth mindset, impairs empathy, makes sure you don’t learn from your mistakes, and leads to an unhappy life.  Every now and then I encounter someone in their 60s or older who is an unhappy person and I think, “You failed at life.  No matter how much money you have or anything else, I believe you Missed The Point.”  I think a lack of humility is the first step down that dark path.  If you can’t admit your mistakes and accept responsibility, I don’t want to work with you.

#3 – Continuous improvement.  Do I like students who know A LOT on the first day of rotations?  Or residents who can handle a colic after 3 months?  Sure, who wouldn’t?  But you know what I like at least as much, if not more?  Students, interns, and residents who IMPROVE over time.  They listen to what I have to say, incorporate that feedback, and become better.  That suggests they will continue to do so throughout their career.  Have you heard the statistic that medical knowledge doubles in an incredibly short time?  A medical professional needs to be able to continue to learn once they finish their training.

You know what, I think that’s it.  I usually find that, in any group of 8 students, generally one is below average, one is above average, and the rest are average.  When I think about the students who are above average, they hit each of these three items.  There are a lot of other things I think you should do to be successful, but if you hit these key points, I think you will be well on your way to being a +1.  

It doesn’t seem hard, but you would be surprised at how few students I see achieve this.  More interns and most residents hit all of these, as would be expected given the progressively challenging selection process.  FIRST, you HAVE to aim for zero.  If you are able to accomplish that (and many students don’t), THEN you can think about these steps to try to head towards being a +1.

Blog Update

Hello constant reader! You may have noticed I haven’t posted for the past 2 weeks, in spite of my plan to post valuable content for veterinary professionals twice a week. This is multifactorial, but I am not done with the blog yet! I want to continue to post good content, but plan to continue to do so on an ad-hoc basis, rather than a constant basis. I realize this is not a good strategy for blog success, but now that the information is out there on the internet, hopefully future students, interns, residents, and faculty can find it in the archives.

Reasons for decreased blogging frequency:

  1. I exorcised my demons. I got out the most important, exciting, and passionate topics over the past two years. There is still more to say, of course, but I don’t feel as strongly about making sure everyone knows about it.
  2. I reacquainted myself with a fun hobby during the pandemic, which is consuming a lot of my creative energy. It takes creative energy for me to write blog posts, so I just have less in the tank due to this hobby.
  3. Blogs done for two years should start to hit a point where they have a continual positive trend up in page views. As you can see from the graph above, the opposite has happened. Maybe because I posted all the best content early on? Maybe because I haven’t been promoting it as heavily- doing podcasts, posting on the FB PVMA group, etc. So it’s a little disheartening to continue to scream into the void.
  4. We have reached financial independence, so I don’t have much of a motivation to generate revenue from The Vetducator’s professional services.

I hope you will continue to read and share the information with others! If you ever have a specific question, I would love to hear it and would be strongly inspired to write a post about it. Please reach out: vetducator@gmail.com.

A Tale of Two Interns

I have some bad news.  Life is not a meritocracy.  We all wish we lived in a world where, if you are the best candidate for a position, you get the position.  Unfortunately, that’s not the world we live in.  In our world, who you know has a tremendous impact on your ability to get a position.  Up to 85% of jobs in the business world are found through networking.  In veterinary medicine, this number is probably much lower, but nonetheless many people get a position due to Who They Know.  This is a case study which illustrates this concept.

Intern A is hard working.  She is dedicated to her patients and wants them up and aware after surgery.  She has her own ideas about how to do things and is not very receptive to input from other experts.  She walks around with a chip on her shoulder and rarely looks like she’s enjoying her work.

Intern B is hard working.  She is dedicated to her patients and wants them to be comfortable and pain-free after surgery.  She listens to feedback from others and seeks out others’ opinions.  She smiles constantly and is happy to be at work.

In a just world (which is a fallacy), which of these two interns should get a residency?  Based on my assessment, I would say Intern B.  Now, I’m not the direct supervisor for these interns, so it’s entirely possible there are amazing qualities of Intern A about which I am unaware.  But, from where I stand, Intern B would be the best choice.  Which one actually got a residency?  You probably saw this coming: Intern A.

This doesn’t mean that you shouldn’t TRY to be the best.  Chance favors the prepared, so if you happen to get a position somewhere with the right people, if you are more enthusiastic, more professional, and more engaged, you are more likely to successfully get your next position.  So absolutely do this: try hard, work hard, be pleasant to work with, have a good application packet.  All of these will help.  But, at the end of the day, it often comes not to who you know, not what you know. 

So some additional advice: cultivate your professional relationships, and reach out to people at institutions where you’re applying. However, if you don’t get the residency you wanted, try not to get too discouraged, criticize yourself, or take it personally. It might have nothing to do with you and everything to do with who someone else knew. Besides, you never know how much happier you might be with your second, third, or fiftieth choice!

Asking Non-Veterinary Supervisors to Write a Letter of Recommendation

A letter of recommendation (LOR) is one of the cornerstones of your application to vet school.  They are used to demonstrate to the selection committee that you know what you are getting into and have the fortitude to succeed.  At least one of your LORs should come from a veterinarian.  They have been through vet school, they know what it takes, and they understand the field.  But what do you do about letter writers who are not veterinarians?  They may need some guidance to write you a really good LOR.

The LOR is different depending on the culture.  In the United States, the LORs we write and receive are much longer than overseas.  The LORs in veterinary medicine are different from those in human medicine.  As a result, you cannot simply trust that a letter writer knows what is needed and appropriate to say in an LOR for vet school.

Far and away the most important positive part of an LOR is the free-text portion.  There are standard questions which are answered, but most of these merely establish the applicant as acceptable or not acceptable.  Where the LOR can really help the applicant stand out from the crowd is in the free-text portion.

That piece of information right there is key.  Many LOR writers don’t spend much time on the free-text portion at all.  They NEED to.  Most American evaluators interpret very little written in the free-text portion as “This writer doesn’t know the applicant”, “This writer has nothing good to say about the applicant”, or “This writer doesn’t know the cultural norms of veterinary medicine.”  Any of those are bad news for the applicant.

So, the first thing you need to impress on your LOR writers is that they need to complete the free-text portion, and not write only 3-4 lines.  It doesn’t need to be a textbook, but most free-text portions I write are a short 5-paragraph essay.  This demonstrates that I know the applicant well enough to comment on their qualities in depth AND put those qualities into context for the position to which they are applying.

I realize it can already be intimidating to ask someone to write you a LOR.  How do you tell them what to write?  After you have secured their agreement to write you a GOOD LOR, you can send them them an email along the lines of:

“Thank you again for agreeing to write me a LOR for veterinary school!  I’m not sure how many of these you have done.  The LOR for vet school is very particular.  The evaluators really want to see that you know me as a person and can ‘vouch’ for my competence and likelihood to succeed.  Evaluators expect that LOR writers put in a detailed and fair description of the applicant in the “Comments” section at the end of the form.  If you can make sure to address a few qualities that you think make me a particularly good applicant, and your experience seeing those qualities, that would be tremendously helpful.  Attached is an example of an LOR written for vet school.  Please let me know if you have any questions!”

If you are more comfortable having this discussion in person, that also works just fine.  You could even discuss it during the same conversation where you ask for a LOR.  “Thank you for agreeing to write for me!  I’ve been told that vet schools are very particular about what they want to see in an LOR.  Can I send you an example for some inspiration?”

I realize this may be more forward than some people are comfortable being.  Some may believe they will offend the LOR writer.  I don’t think that’s the case.  Anyone willing to write you a GOOD letter WANTS you to succeed.  They should be delighted to get any guidance to help them write a LOR which would help you be successful.  I have written a handful of LOR for medical school and I know I would have appreciated more details about what they are looking for or even an example.

You can’t expect everyone to know what veterinary medicine cultural standards are, so you need to help them out.  Be respectful and polite and approach it with an attitude of helpfulness.  I think this will improve the qualities of LORs I read and improve YOUR chances of getting an interview and acceptance.

My Ideal Candidate

I do not represent every veterinary professional.  I think that should be obvious, but I have to make that VERY clear for this particular post.  I have spoken with many veterinary professionals and academics, and I have trained dozens of house officers and thousands of students, and there are numerous ways to approach success in veterinary medicine.  I don’t think many people would argue with the principles I have in the How to Be Successful series.  I suspect some people may argue with my ideal candidate.  Nonetheless, I want to share with you my ideal candidate and why I believe they are the ideal candidate.

No matter the position- vet school, internship, residency, or faculty position- I have a short list of essential criteria.  I want them to be interested in working hard.  I want them to be humble.  And I want them to be pleasant to work with and able to get along with people.  I have heard this summarized as “hungry, humble, and smart.”  Why do I look for these particular qualities?

Hungry

Nobody wants to work with someone who is lazy.  Vet students who don’t work hard won’t learn what they need to pass, much less be successful veterinarians.  Interns who don’t work hard don’t learn to be competent clinicians.  Residents who don’t work hard are the worst- they drag the entire team down for years until they are let go.  Faculty who don’t work hard don’t usually impact me directly, but it’s a little disappointing to witness.  Step #1 is to Show Up.  You can’t be successful if you’re not there.

Humble

As a general rule, people who are humble are more teachable, they are interested in personal growth, they realize they are imperfect, and they acknowledge their mistakes.  Being humble is NOT the same as lacking confidence.  You can be humble and confident.  You can’t be humble and arrogant.  Who really wants to work with someone arrogant?  As a student, intern, or resident, I can’t teach such a person.  As a faculty member, they won’t admit to mistakes and instead push them off onto others.  I believe humility is essential to becoming a fully self-actualized, happy human being.  It’s also critically important in medicine, where you absolutely will make mistakes and need to deal with them.  One surgeon I worked with had a saying, “If you haven’t seen a complication doing this, you haven’t done enough of them.”

Smart

If someone doesn’t know something, I can teach them.  In fact, that’s my job.  But if they aren’t pleasant to work with and get along with people… I can’t fix that.  That’s going to take years of therapy on their part.  I’m not a therapist.  Who wants to work with someone unpleasant?  Everyone has their bad days- that’s OK.  But if someone doesn’t know how to deal with conflict, is constantly negative, puts other people down, or doesn’t show respect, I don’t want to be around that person.  You don’t need to be extroverted and outgoing and always “on”.  But you do at least need to understand that other people have feelings, they are trying to get through their day the same as you, and you need to work together to accomplish that.

It’s not a long list.  It doesn’t seem hard.  You don’t need to EXCEL in each of them.  I would argue I am reasonably hungry (though not as much as some), reasonably humble, and still working on developing my emotional intelligence.  But you DO need to at least be aware of each of these and, if you aren’t doing well yet, working to improve them.  The students, interns, residents and faculty I have seen fail have completely lacked- and been uninterested in improving- at least one of these.

This is why my ideal candidate focuses around these qualities.  There is some baseline assumption of intelligence, but anyone who gets into vet school I believe is sufficiently smart to become excellent, as long as they also have these three characteristics.  When I look through applications, I look for evidence that the applicant has OR DOES NOT have these qualities.  What qualities do YOU think are most important?

Red Flags in Faculty Positions

I think it’s actually quite hard to find out if a job/faculty position will be a poor fit for you until you work there for a while.  I have seen numerous people (including myself) take positions they thought would be good for them, only to discover those positions weren’t good.  Finding red flags before taking a job is quite challenging.  Here are some I can think of.

  1. Frequent turnover.  If the faculty turn over regularly, if they have a large exodus, or if they have a large number of positions open, that may suggest a systemic problem. You can ask about this phenomenon, and sometimes reading between the lines of the answer will give you an idea of whether it’s just bad luck or if there’s an actual issue.
  2. Too good to be true.  I think this applies to almost everything in life.  “If it’s too good to be true, it probably is.”  Some examples: A $100k signing bonus without a multi-year contract; a high salary with low clinic time and minimal research expectations; any excessive verbal promises.
  3. Poor leadership.  If the leader is a narcissistic sociopath, it’s probably not a great long-term position.  Hard to discover without a psych evaluation, though.
  4. Unhappy faculty.  Even if they aren’t leaving and creating high turnover, if the existing faculty are all miserable, that’s a bad sign. Again, this can be hard to establish, but a lot of times faculty will try to convey such issues even if they feel they can’t be brutally honest. 

Again, it’s hard to identify permanent positions which are bad fits.  Unfortunately, sometimes the only thing to do is try it out and see if it works for you.  If it doesn’t work out, specialists are always in demand, and you can probably find a better fit somewhere else. Unless YOU’RE the problem.

Red Flags in Residencies

The purpose of a residency is to prepare you to pass boards and train you to be a specialist clinician.  As long as you achieve that objective, then the residency is a success.  However, residencies are 2-4 years long, and you don’t want to suffer for that long if you work somewhere terrible.  These are the red flags I would consider when looking at residency programs.

  1. Low boards pass rate.  While those training residents SHOULD be focused on helping them pass boards, some programs just throw the resident to the cases without journal club, classes, or boards prep time.  Although practicing your specialty is necessary to pass boards, it’s not sufficient.  Find out what their boards pass rate is.  If it’s less than 80%, I would be worried.
  2. Low credentials acceptance rate.  For many specialties, you have to submit a case log and other materials indicating you are qualified to take the specialty board exam.  Some programs are notorious for not preparing their residents for credentials submission.  I see this most often with specialties that require an accepted peer-reviewed publication and programs that don’t do a good job of making sure their residents complete a publishable paper in time for credentials submission.  Again, ask what their credentials acceptance rate is.  This should be 100%; if it’s less than that I would ask where the problems were- it’s possible one resident didn’t do what they were supposed to.  But if more than one resident had a problem with this in the past, I would be suspicious of the program.
  3. Miserable residents.  Look, a residency is HARD- it’s not usually a time of puppies and rainbows.  But it shouldn’t be TERRIBLE.  If the current (or previous) residents all report that they get abused, or overworked, or yelled at, this is probably not a good situation to enter into.

Those are really the ones I can think of.  If a program has a good track record of credentials acceptance, boards pass, and not-miserable residents, it’s probably a reasonable residency experience.