Program Director Q&A

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Is there a component of an application that you find correlates best with or is most predictive of a resident's performance in residency? (e.g. board scores, research experience, clinical grades, etc)

I've seen studies that use passing the Core exam as the benchmark, but would be interested in your anecdotal experience with the more intangible things that make someone a great radiology resident.

This is such a fantastic question and gets to a very core challenge of the current system in selecting candidates. Simply put I have yet to find anything that clearly predicts success in residency. Furthermore, a great resident does not necessarily make a great fellow or a great attending. The other thing that I would add to this question, which by no means is trivial, is in fact the same resident might do very well in a specific program and less so in another. In other words, there are so many confounding variables that finding signal over noise has been impossible. 

So, why do we not randomly select and spend so much time going through applications and interviewing people? In part my hope is that applicants get a sense of who we are in interviews, when combined with the soul searching that comes from being asked hundreds of inane questions by dozens of people through the interview trail, leads the candidate to select the programs that fit them best. I firmly believe that this is the best way to match residents to programs and why we try to be very open and transparent about our strengths, weaknesses, aspirations, etc. We make all of our residents available to all of our applicants as well for the same reason.

I realize I have not answered your question yet. In fact, there are certain things that I have become biased towards in selection. If an applicant has been a waiter or waitress for more than a summer I think this is very predictive of success. I suspect they learn how to multitask, be in a high pressure environment while maintain a good attitude, understand customer service, and hard work. Crew athletes similarly work incredibly hard. But to do so that early in the morning, frequently with a group of rowers (that precludes individual fanfare or ego) teaches the importance of teams and hard work in a way that tends toward success. We've also had many professional and NCAA athletes who similarly tend to do well. Along these same lines an applicant who has tackled a research question deeply, with as many failures as successes through their quest, tend to have the perseverance and dedication necessary for success as a resident. An applicant who has done a lot of writing and authoring of papers tends to write and author papers in residency as well. A last anecdotally predictive concept I would like to share is best summarized as "distance traveled." Hardships of any sort that helped to frame a person's world view, solidify their grit, and rise above adversity tends to result in a great resident and a treasured colleague.

Notice that I didn't mention scores or grades. These too are confounding and confusing variables. Not all clinical grades are created equally. Hilariously some school's honors grade is equivalent to another school's pass if you look at the histogram of the grade distribution, if that happens to be provided at all. The same can be said of the code words used to relatively rank students in the MSPE. In theory AOA, or more so Gold Humanism Honor Society (given the peer-based election), would be markers of academic and interpersonal excellence. Unfortunately, like so much in society broadly and medicine specifically these are not equitably awarded and have clearly demonstrated ...ahem...lack of representative distribution. In effect this perfectly contrasts a foundational guiding principle of our selection process. In the spirit of answering your question and stating absolutely clearly, I have not seen a clear correlation with these honors and resident excellence.

While it might be the case that board scores predict future board passage rates I think the threshold is much lower than assumed. For this reason and some others I support changing the USMLE exams to pass/fail.

I think the most important point to make is that almost all residents in almost all residencies do fantastically well. This is a great thing and ultimately makes it much harder to be certain of what characteristics might be specific markers of success. Good luck!!

If I have not received an interview, would it be ok to send an email stating my interest?

Yes, of course it is OK to send an email. And I answer every one!! But it is very rare for a decision to be changed. I have been told that sometimes my responses are terse--I do not mean any offense. It is the only way to keep up with the sheer volume of email.

Thank you for being transparent in your interview process. Relating to a question answered, other than interviewing low step 1 applicants, do they ever make it onto your rank lists?

Thanks for this question! We would never interview a candidate who we don't think we would rank. The answer is unequivically YES, sorry I was not more clear in my previous answer. They also make it into our residencies and end up being just as fantastic as our residents with higher USMLE scores. It is how I know the USMLE is a poor predictor.

Interview invitations

OK not a question but so many tweets and our experience last year with applicants signing up for interviews within 100 ms of the invite prompts me to speak up against the practice. We never invite more candidates than the number of spots so if you get an interview you will be able to schedule it with us. What about a specific date desired? Of course that cannot be guaranteed but we have always had enough movement on the interview schedule that this mostly works  out. This is one clear advantage of the new virtual interview paradigm. In some cases we have made special accomodations to allow for a candidate to interview. We also try to coordinate days with local programs in order to make travel  cheaper and easier for our applicants. We recognize that this is a hectic, stressful, and expensive time and we aim to decrease all of those things to the extent possible. Good luck!!

Are residents with significant others and/or children able to comfortably afford living in the area (eg, 2-bedroom apartment) with the current salary and benefits?

Guest answer from our chief residents:

This is a valid concern that many applicants have. The primary purpose of the additional housing stipends Stanford offers is to help offset the cost of living, and as a result, our annual take-home salary is significantly higher than other residencies.

Many current residents have significant others, and several have kids.

Monthly rent varies drastically depending on the town you live in. Consider researching online (Craigslist, apartment websites) to get an idea of the range of rents in the cities surrounding Stanford. Also remember that if you apply early enough, Stanford offers subsidized on-campus housing.

Ample moonlighting is available starting your first year to supplement your income.

GME housing resources here.


Do you interview applicants based on geography?  I'm from a school in the East, but I'm from the West so I have a real reason to want to go to Cali other than that it sounds exotic.  How should I communicate this intent to you?

I get this question a lot, and have tried to make our philosophy clear on this site (and to some extent in the IR answer below). We aim to recruit the best candidates, regardless of their intent to come here. My job is to convince you that Stanford Radiology is the best training program for you, and try to earn your decision to join us, even if you were not planning to live here. Of course I understand that being from California is a great reason to want to come back but that will unfortunately not make you any more likely to interview or be ranked.

Do you accept DOs?

Our goal is to recruit a diverse class of the best candidates in the country who are able to take unique advantage of the opportunities we have here. We take a very broad view of diversity and (under)representation in radiology, which includes DO candidates. We have not yet matched any DO candidates but have interviewed many.

Is there a STEP 1 score cut-off or baseline you use when reviewing an application?

We do not have a Step 1 score cut-off and have interviewed candidates with Step 1 scores below 200. We recognize that the USMLE scores are an imperfect measure of applicant success. Having said this, there is unfortunately a dearth of objective data with which to compare applicants and USMLE does play a role. In the interest of full disclosure, for the most recently available data our matched applicant mean Step 1 score was 249 and mean Step 2 score was 256.

We also recognize that students are likely applying to far too many residencies. Please read through the application guidelines section of our site to learn more about the types of applicants we are looking to recruit prior to applying.


Would I still be considered for an interview if you received my Step 2 score later, and when would that be? I want to compensate for my low Step 1. 

The application deadline is October 1 so any data added to your application until October 1 will be reviewed. I will take this opportunity to discuss our process and rough timeline.

Since we do not have a boards cut off it makes it more challenging to fully evaluate the large number of applications we are blessed to receive. In addition, to mitigate bias, we have at least 3 faculty go over each application we receive. This is a lot of work! But we make this investment given how important this is and to respect each of people who made the effort of applying to our residency. This first screening promotes less than half of the applicants to further consideration. 

Next, individual faculty evaluate 5-8 applications each, in far greater depth. In general these faculty review graduates from the same schools year after year, and tend to have some connection to the school or region. This allows our evaluators to learn the grading scheme and style of MSPE of each school, which is sometimes very difficult. It also allows for more fair comparison of applicants.

Our aspirational goal is to begin sending invitations to interview by early November for December and January interview dates.

How do you adjust for grade inflation over time when evaluating Step 1 scores given that these scores have risen over time? Especially for M.D./Ph.D.  or otherwise unconventional students.

I can't say that we adjust per se but that we don't allow USMLE scores to wholly determine our decision. Please see answer above.

Do you require Step 2 for ranking?

We do not require Step 2 scores for ranking.

Are IR applicants penalized on the DR rank list?

If an applicant submits applications to both the DR and IR/DR pathways at a given institution, how would the DR program treat that applicant? Would it be viewed as any other application would be? I have heard speculation/rumors that DR programs are hesitant to interview/offer applicants who have expressed strong interest in IR due to a variety of reasons and was curious at least how this was viewed at Stanford.

This is clearly a hot topic! First of all, I can’t speak for other programs so this answer may not be broadly applicable.

Simply put, applying to both IR and DR (and NM for that matter) has absolutely NO bearing on your chances for IR or DR or NM individually. I am interested in bringing on the best people, and if they are also applying to IR it is my job to try to recruit them to DR, and Will Kuo (IR PD) the opposite. In this way we both stand to win since these residents will have identicaly R1-R3 years and will of course spend time on one another's services to a lesser or greater degree in the R4 year as well.

The “cost” for me (and why I assume this rumor even exists) is that you might decide that you would want to do IR no matter what and you will rank our DR program very low. This doesn’t apply for two reasons: 1) based on our experience 1/2 of IR applicants choose us (ie DR) above other IR programs meaning that I would miss out on 1/2 of a group of potentially phenomenal residents and 2) My rank list is not how I measure my value or the strength of our program. Now I’m lucky in that I have incredible support through the department from the Chair down so I don’t need to mess with the rank list to pretend/project that I’m doing better.

I have heard that some programs do operate in this way (and apparently make it very clear to applicants) so you might run into issues with those programs applying to both. This also applies to post interview communication. It boggles my mind that applicants and programs might change their ranking based on the perception that one desires the other more. To me this is simply “looking for love in all the wrong places.”

To put it another way, both DR and IR at Stanford routinely rank to match some of the same applicants. If your goal was to win a rank order list competition this would be dumb since only one program could “win” that resident. To me that totally violates the spirit and the intention of the Match, which is to empower applicants and allow for programs to try to get the best applicants possible. Please read this paper, which very clearly lays out the argument to rank who you truly want to match.

Good luck!

When can you start moonlighting?

You may start as a first year. There are moonlighting opportunities available throughout your residency.

Radiologists prefer the dark. How do you cope with the California sun?

I sense sarcasm and a little sensitive yet about my humor so, a serious answer. From Harriet Hunter in Cambridge (tip of the hat to Dr. Kotsenas) a word cloud of medical students perception of radiology. Huge misperception of radiology out there, we need to work harder to correct these grossly inaccurate stereotypes. Though I freely admit this Q&A is snarky. Hopefully not soporific.

We are on the cusp of a significant reboot of the medical school clerkship with increasing involvement of residents and medical students, which we hope will help.

your sense of humor is so lame and forced

Now this is not a question but comments are welcome as well. Let me remind you that I'm a radiologist. If my humor were dynamic, unforced and, most of all, funny, I might have been a performer, maybe on TV or in the movies. At least I have my health.

Does Stanford accept international medical graduates?

Yes, we recruit the most qualified candidates who we feel will be able to take advantage of the unique resources of the Stanford Department of Radiology and Stanford community in general. Our GME office uses the J-1 visa program. Read more here and here.

Will it help if I send an email indicating my interest in matching?

We rank candidates purely based on the strength of your interview, application, and the committee's impression of how well you will fit in the unique culture we have established and are striving to build upon. While I am flattered and humbled by your interest, and will respond to any questions you may have (usually more tersely than I would like but the only way I can keep up with them all), you should not feel forced to send a note in order to match. Good luck!