Questions to Ask at an Emergency Medicine Residency Interview
An emergency medicine program is hard to judge from its website: annual visits and a list of rotations say little about how many patients an intern carries or who takes the airway. These 64 questions to ask at an EM residency interview are for fourth-year students and other applicants, and they follow the order in which a program comes into focus: the department and its patients, life on shift, procedures, the curriculum, how residents live, and what becomes of them. The list is written for the US match, and a good share of it is meant for residents when no faculty are in the room.
The questions
Each question, and why to ask it
The department
How many patients does this emergency department see in a year, and how many residents and other learners share them?
Why ask it
Annual volume means little until you divide it by the people picking up charts: residents from every class, off-service rotators, students and advanced practice providers. A department that sounds busy can still leave an intern waiting for a patient when six learners are on the same shift.
What sort of patients come through here, and what would I see that I would not see elsewhere?
Why ask it
Case mix is the substance of the training: penetrating trauma, obstetric emergencies, toxicology, pediatrics, geriatric medicine. Ask what they are short of as well, since every department has a gap and honest programs will name theirs.
How sick are the patients here: what share are admitted, and how many go to intensive care?
Why ask it
The admission rate is a rough measure of acuity that a program director will usually know offhand. Follow it up with a resident: is the resuscitation bay in use on most shifts, or a few times a week?
Which hospitals do residents work in, and how is the time divided between them?
Why ask it
A county hospital, a university center, a community department and a veterans' hospital each teach a different way of practicing. Have a senior tell you which site made them feel like the doctor, and whether the sites are close enough that a car is optional.
Who leads a trauma resuscitation here: emergency medicine, surgery, or do they alternate?
Why ask it
Arrangements differ a great deal. In some hospitals the EM resident runs the room, in others EM holds the airway while surgery leads, and some split it by odd and even days. Pin down which it is and in what year an EM resident first leads one.
When admitted patients wait in the department for a bed upstairs, where do residents see the new arrivals?
Why ask it
Boarding fills rooms that would otherwise turn over, so new patients may be seen in hallway chairs or the waiting room. Find out how many beds are usually held that way, and whether residents keep managing the boarded patients or an inpatient team takes them over.
What share of the patients are children, and are they seen in a separate pediatric emergency department?
Why ask it
Children may be mixed into every shift or seen in blocks at a children's hospital across town. A minimum of pediatric experience is required either way, so ask how it is met here, and whether a resident keeps seeing children in every year or only in one concentrated stretch.
Who else sees patients in the department, and how is it decided who picks up which one?
Why ask it
Where a fast-track area staffed by physician assistants or nurse practitioners takes every laceration and sprain, residents can finish without learning to move simple cases quickly. What those colleagues do depends on the state and the employer, so have someone describe the split in this department.
How are patients in a mental health crisis cared for here, and what is the resident's part in it?
Why ask it
Some hospitals have a psychiatric emergency service next door and others keep these patients in the main department for days. The law on involuntary holds differs by state, so ask how it works there, who reassesses the patient each morning, and what de-escalation training residents get.
Who employs the emergency medicine faculty: the university, the hospital, or a contracted staffing group?
Why ask it
Attendings may work for a university, the hospital itself or an outside group on contract, and a lost contract or a sale of the hospital can replace the people you came to learn from. This is one for the program director: how long has the present arrangement stood, and is any change expected?
How long have the program director and the department chair been in their roles?
Why ask it
A director who arrived last year may still be remaking the program, and one about to step down will not be the person who signs your evaluations. Neither is a bad sign in itself. What you want is to hear about a planned change today and not in an email after the match.
On shift
How long are shifts, and how many does each class work in a month?
Why ask it
Shifts of eight, nine, ten and twelve hours are all in use, and the monthly count usually falls with seniority. Write down both figures for every year, because twenty shifts means something very different at eight hours and at twelve. Then ask what the heaviest month comes to in hours.
How are nights scheduled, and how fast does the schedule turn from nights back to days?
Why ask it
Averages hide the bad weeks. Find out how many overnight shifts come in a row, whether shifts move forward around the clock from days to evenings to nights, and what the shortest turnaround was on last month's schedule.
How many patients does an intern usually carry at once here?
Why ask it
An intern holding three patients at a time and one holding eight are having different first years. Get the number from an intern, not the brochure, and ask whether anyone steps in when the board gets ahead of them.
What pace is a senior resident expected to reach, and do residents see their own numbers?
Why ask it
Many employers track patients per hour, so a program ought to be building toward a working pace by the final year. The thing to learn is whether those figures are handed to residents privately as coaching or posted as a ranking.
Do shifts end on time, or do residents stay on to finish charts and dispositions?
Why ask it
Put it to a resident as a question about yesterday: what time did the shift end, and what time did you leave? Some schedules overlap by an hour so that nobody picks up a new patient near the end, and without that a ten-hour shift can quietly become twelve.
How is sign-out done at change of shift, and is an attending part of it?
Why ask it
A patient handed over halfway through a workup is easy to lose track of. Listen for a fixed routine, a place away from the noise, and a rule about who owns the patient still waiting on one scan.
Who is in the department at three in the morning: how many attendings, residents and nurses?
Why ask it
One attending covering every bed with two residents is a different night from the afternoon's full team. Ask as well what leaves the building after dark, such as an in-house radiologist, ultrasound technicians or the consultants, because those gaps decide how much a resident handles alone.
Does a resident present every patient to the attending before acting, and when does that loosen?
Why ask it
You are listening for a gradient. Interns present first and then order; seniors start the workup and tell the attending the plan. If a final-year resident still needs a signature for every decision, ask what that year is meant to add.
When does a resident start running a section of the department and supervising juniors?
Why ask it
Watching the whole board, answering the radio for ambulance crews and teaching an intern while staying on pace are the skills of a first attending job. Get the year each one begins, and whether the attending really stands back on those shifts.
Who decides which patient a resident sees next: the resident, the attending, or an assignment system?
Why ask it
Self-selection lets quick seniors take the sickest patients and can leave interns with whatever remains, while assignment evens it out. Under either system, ask whether anyone checks that each resident is seeing a spread of complaints and not only the ones they like.
How do residents chart here: scribes, dictation, or typing every note themselves?
Why ask it
Documentation habits formed in residency follow you into practice, and so does the speed. Check which record system each site runs, since switching between two of them every few weeks costs real time on shift.
Procedures
What procedures do residents graduate having done, and how are the numbers tracked?
Why ask it
Ask to see a recent graduate's logged totals beside the minimums the accrediting body sets, not a list of opportunities. The gap between the two shows whether intubations, central lines and chest tubes are routine here or have to be hunted for.
Who manages the airway in the department and in the trauma bay: emergency medicine or anesthesia?
Why ask it
In some hospitals anesthesia takes the airway on alternate days, for children, or whenever one looks difficult. Ask who intubated the last trauma patient and the last patient who came in fighting for breath, and whether the hard ones stay with the EM team.
Which rare procedures do most residents here only ever do in a simulation or cadaver lab?
Why ask it
Surgical airways, thoracotomies and pericardiocentesis are uncommon everywhere, and the accrediting body lets some required numbers be met in simulation, so ask for the current rules. An honest list and a lab that runs every year beat a claim that everyone gets one on a live patient.
Are there fellows or rotating residents in the department who are ahead of EM residents for procedures?
Why ask it
Pediatric emergency fellows, critical care fellows and surgical residents can each be first in line for the thing you came to learn. A senior can tell you when they last lost a procedure to someone else, and whether it happens weekly or once a year.
How much ultrasound do residents do themselves, and who teaches it?
Why ask it
Some departments scan on nearly every shift and have faculty who go through the saved images each week; others own a machine and give an annual lecture. Ask how many scans a graduate has logged, and who told them when one was read wrong.
Who runs a cardiac arrest or a medical resuscitation here, and what is the intern's job in the room?
Why ask it
Leading the room is a separate skill from doing the procedures inside it. Interns may be given compressions or the airway, or may watch from the doorway, and a senior can tell you the month they first stood at the foot of the bed giving the orders.
What is simulation used for here, and how often does each resident take part?
Why ask it
Its best use is the event you may meet once in training and must still manage: the crashing infant, the failed airway, the delivery in the hallway. Have a resident describe their last session, and take a blank look as your answer.
How are fracture reductions, wound repair, nerve blocks and procedural sedation taught?
Why ask it
These everyday skills fill far more of a career than the dramatic ones. Hospital rules decide who may give sedation, so ask whether EM residents do their own here, and whether orthopedics is called for every reduction or only the hard ones.
Curriculum
Is this a three-year or a four-year program, and is that about to change?
Why ask it
Both lengths have run side by side, and the accrediting body has been reviewing its requirements on length, so ask what will apply to the class you would join. In a four-year program, ask what the last year holds that a third year elsewhere does not; in a three-year one, ask what gets squeezed.
How are the off-service rotations spread across training?
Why ask it
Get the months by name and by year: obstetrics, anesthesia, orthopedics, the intensive care units. An intern year spent largely outside the department is common, and a program that still sends seniors off service for long stretches should be able to say why.
Which intensive care units do residents rotate through, and what is their role on those teams?
Why ask it
Medical, surgical, cardiac, neurological and pediatric units each teach something different, and a minimum of critical care time is required, so ask what it is now. What matters most is whether the EM resident carries patients and does the lines and airways, or rounds as a guest of another department.
Which off-service rotation do residents rate lowest, and why is it still in the curriculum?
Why ask it
There is always one month the residents would drop if they could. A director who names it and says what is being done has given you a straight answer, and you can check it by asking a resident the same thing later in the day.
What does the EMS experience involve: ride-alongs, medical direction over the radio, flights?
Why ask it
Prehospital experience is a required part of training and is filled in very different ways. If residents fly, ask whether it is optional and what insurance covers them in the aircraft. On the ground, the difference is between riding along as an observer and being taught how an EMS system is run.
How is toxicology taught, and is there a poison center or a toxicologist on the faculty?
Why ask it
Some programs send residents to a poison center for a month, and others rely on conference and whoever is on shift. If it is the second, ask who a resident phones about an unusual overdose in the middle of the night.
What happens at weekly conference, and are residents released from shifts to attend?
Why ask it
Get the hours per week, who covers the department meanwhile, and whether the resident coming off a night shift is expected to stay for it. Then ask a resident what last week's session covered; a quick, specific reply means people go.
How much elective time is there, and what have residents done with it lately?
Why ask it
Recent examples beat a brochure list: an extra ultrasound month, a rural department, work abroad, time with a ski patrol or a sports team. Ask too whether salary continues on an away elective and who pays for travel.
Do residents teach medical students on shift, and is anyone taught how to do it?
Why ask it
Students are on most shifts in many academic departments, and teaching at the bedside without falling behind takes practice. See whether seniors get dedicated teaching shifts where they supervise instead of carrying their own patients.
How does intern year begin: an orientation block, or straight onto the schedule?
Why ask it
A few weeks of procedure labs, ultrasound teaching and paired shifts is one way to start, and a first shift on July first is another. The newest resident you meet will remember who stood beside them that day.
Is a research or scholarly project required to graduate, and is there protected time for it?
Why ask it
What counts runs from a published study to a quality improvement project or a conference lecture, so ask for last year's examples. Protected time is the test: without hours attached, the work lands on days off, which is how projects quietly stop.
How do residents get feedback when the attending changes almost every shift?
Why ask it
Comments may be collected on a card or an app after each shift, or saved for a twice-yearly meeting with someone who was not in the room. Ask a resident for the last piece of feedback that changed how they practice; few people can name one, and those who can are describing a program that does it well.
When a resident falls behind, academically or personally, what does the program do?
Why ask it
Every program has residents in difficulty, so an answer that this has never come up is not credible. Look for a described process, named people, and an example of someone who was carried through a hard year and graduated.
Resident life
What happens when a resident is involved in a case that goes badly?
Why ask it
You are asking about the mechanics: who tells them, whether they are taken off the floor, whether there is a review, and who checks on them afterwards. Listen for whether that review looks at the system the resident was working in or only at the resident.
What does the program do about the parts of this job that follow people home?
Why ask it
The details matter here: whether counseling is confidential and paid for, whether it can be reached without using your own days off, whether anyone talks after a pediatric death. If the first thing mentioned is a gym membership, you have learned how far the thinking goes.
How safe do residents feel on shift, and what happened the last time a patient hurt or threatened one?
Why ask it
Security at the doors, a way to call for help from inside a room, and what followed the most recent incident are the three things to hear about. A department that calls it part of the job has told you how a report from a resident would be received.
How does the schedule cope with illness, parental leave, or a family emergency?
Why ask it
Someone in each class will need this. Ask who covers the shifts, whether the time is made up later, and whether residents feel able to call in sick, which is a different question from whether they are allowed to.
How often is the backup resident actually called in?
Why ask it
Most programs keep someone on standby for sick calls, under one name or another. If that person comes in most weeks, the schedule has no slack in it, and residents start working ill to spare a friend.
How are vacation and the winter holidays handled in a department that never closes?
Why ask it
Check whether time off comes as whole weeks that are held for you or is assembled from days without shifts, and how the holidays are divided between classes. Leave rules and their effect on board eligibility change from time to time, so ask what applies to your class.
Can residents live comfortably on the salary here, and where do most of them live?
Why ask it
Pay, meal money, parking and health cover are fair questions for a resident or the coordinator, who can also point you to the sample contract. Whether residents are unionized depends on the hospital, so ask, and ask whether most people can afford to live alone near the main site.
Can residents moonlight, from which year, and where?
Why ask it
The program, the hospital and the state licensing board each have a say, so ask how it works there and how the hours are counted. Find out whether the shifts are inside the system with backup or single coverage at a small hospital.
With everyone on different shifts, when do the residents actually see each other?
Why ask it
A class on shift work is seldom all off at once, so closeness has to be arranged. Listen for something concrete, such as a retreat with the department covered or a standing meal after conference, and watch how the residents talk to each other at lunch.
What is the working relationship like with nursing and with the services you consult most?
Why ask it
An emergency physician phones a consultant many times a shift, so friction with one admitting service, or with the nursing staff, colors every day and is rarely mentioned by faculty. Ask a resident which call they dread making.
What has changed in the program in the past two years, and what prompted it?
Why ask it
This shows whether residents can influence anything. A specific change traced to a specific complaint is a good sign; a list of new facilities with no mention of residents asking for them is a weaker one.
What kind of resident does well here, and what kind does not?
Why ask it
The second half is where the useful information sits. A department that hands interns the room early and one that builds up slowly suit different people, and a director who knows which they run will say so.
If you could change one thing about this program, what would it be?
Why ask it
Ask residents rather than leadership. An answer of nothing means either a rehearsed day or someone who does not trust the room; a specific, minor complaint delivered without anxiety is usually the best sign you will get.
Is there a resident I could email with the questions I think of after today?
Why ask it
Programs set their own rules on contact after the interview, within the match's code of conduct, so hear theirs before you write to anyone. A named resident who answers candidly a week later is worth more than a polished thank-you exchange with the director.
Outcomes
Has anyone left the program in the past five years, and what happened?
Why ask it
People leave for another specialty, for family, or because a contract was not renewed, and those are three different stories. A straight account, even of something painful, is a better sign than a smooth denial.
How have recent classes done on the in-training exam and on their boards at the first attempt?
Why ask it
Ask for several classes, not the best year. The certifying board has reworked its exams before, so find out how the sequence will run for your class and what the program does for a resident whose in-training score comes back low.
Which fellowships have residents gone into lately, and are any of them run from this department?
Why ask it
Ultrasound, toxicology, EMS, critical care and pediatric emergency medicine are the usual routes, so name the one you have in mind. A fellowship down the hall puts mentors and letter writers within reach, and a program without one should be able to say where its residents were accepted instead.
Where did the last two graduating classes go?
Why ask it
The actual list is what you are after: academic posts, community departments, staffing groups, fellowship, and in which cities. If nearly everyone stays in the same hospital system, find out whether that was a choice or simply where the program's name is known.
How did last year's seniors find their jobs, and how early did they start looking?
Why ask it
The market for emergency physicians shifts by region and by year, so a recent class is the only fair guide. Ask whether the seniors had offers where they wanted to live, and whether the program brought in alumni and employers or left each person to search alone.
Does anyone teach the business side: billing, contracts and malpractice cover?
Why ask it
A first contract raises things no shift teaches, such as how pay is calculated, who pays for malpractice cover after you leave, and what a non-compete clause would stop you doing. The rules differ by state and employer, so the useful program is one that teaches residents which questions to take to a lawyer.
What do recent graduates say they were not ready for in their first job?
Why ask it
Answers you might hear include speed, being the only doctor in the building, and arranging transfers out of a small hospital. A director who has put this to graduates and changed something as a result runs a program that keeps listening after graduation.
Using your questions well on an EM residency interview day
Practical guidance for the conversation itself
Ask the right person
Program leadership
Take the questions about structure: the length of the program, off-service allocation, who employs the faculty, board results and where graduates go. Most of Curriculum and Outcomes belongs here, because the answers are matters of record and the director has them to hand.
Residents, especially interns
Ask about patient load, staffing overnight, sick calls, and what they would change, which is most of On shift and Resident life. Interns are close enough to the transition to remember it and far enough in to have opinions. Anything involving morale is worth asking twice, to two different people.
Chief residents
They know how the schedule really works, what happens when someone needs cover, and which rotations residents dread. Save the scheduling questions for them.
Faculty interviewers
An attending who works clinical shifts can speak to The department and Procedures from the other side of the conversation: how much they let a senior run, who takes the airway, what boarding has done to bedside teaching. Ask about the part of the job they hold a title in, whether that is ultrasound, EMS or simulation.
The resident social, in person or on video
Residents are at their most candid here, and it may still count: some programs ask the residents for their impressions, so assume anything you say can reach the ranking meeting. Ask more and drink less.
How to ask
- Do not ask what the website answers. Ask instead what the website does not: numbers, exceptions, and what happened the last time something went wrong.
- Two or three questions per interviewer is plenty. A list worked through in order reads as a script and eats the time you could use to be remembered.
- Ask the same question at several programs, in the same words, so you can compare. Impressions blur after the fourth interview; comparable answers do not.
- When you get a vague answer, ask for a recent example rather than repeating the question.
- Write everything down within an hour of finishing. By ranking season you will not remember which program said what.
What actually differs between EM programs
Three years or four
Length is the first sorting question for many applicants, and it is easier to weigh once you know what you want next. Put the same question to every program: what does a resident do in the final six months here that they could not have done a year earlier? Requirements on length belong to the accrediting body and have been under review, so confirm what applies to your entering class before you rank on it.
County, university and community sites
Most programs lean on one kind of hospital and borrow the others. A county department tends to offer volume and autonomy, a university center brings subspecialists and fellows, and a community site shows the job most graduates go on to. What separates programs is how many months fall in each and where the seniors say they grew most.
Volume is a ratio
An annual visit count is only useful beside the number of people seeing those patients. Put volume, admission rate, class size and the other learners in the department on one line for each program, and departments that looked alike on their websites will separate.
Who else is in the building
Trauma surgery, anesthesia, orthopedics and pediatric emergency fellows all do things an emergency physician also does. A hospital with every service in house overnight has backup for the sickest patients and may hand them your airway and your reduction. A hospital without them leaves more to the EM resident, with less help nearby. Decide which trade you prefer before interview season, then ask the questions under Procedures with that in mind.
If the interview is virtual
- You lose the corridors, the tour, and the overheard remark, so ask directly about things you would otherwise have seen: the physical layout, where residents actually sit, how crowded the department is.
- Ask for a resident contact you can email afterwards. Willingness to give one, and whether the reply is candid, is informative in itself.
- Ask about the local cost of living, commuting, and where residents live, which you would normally judge with your own eyes.
- If a second-look visit is offered, use it for the questions about culture, not the questions about curriculum.
What not to do
- Do not lead with salary, vacation, or moonlighting. Those questions are fair, but ask them of residents or of the coordinator rather than of the program director in the first five minutes.
- Do not ask a question that is really a statement about how prepared you are. Interviewers notice, and you learn nothing.
- Do not ask where you stand, or about your own chances of matching. It puts them in an awkward position and reveals nothing reliable.
- Do not repeat a question that was already answered in the group presentation. It tells the room you were not listening.
- Do not press a resident who is clearly guarding an answer. Note the reluctance and ask someone else later.