In the midst of multiple crises — the COVID-19 pandemic, the continued attack on Black people and subsequent protests against police brutality, the removal of transgender health care rights and so much more — I have heard discussion about how these issues will be reflected in medical school, residency and related fields’ interviews. Specifically, it will become standard for interviewers to ask about how these events affected applicants, how they reacted to these events and whether they were personally impacted. On the surface, the inclination to ask these questions appears reasonable; however, this approach may actually be crass and devoid of any understanding on a personal level.
Interviewers who ask these questions in a professional setting typically consider these issues to be academic — purely topics for discussion that might provide useful insight into the way the applicant views the world. But for applicants who have been affected, these issues are not merely academic and their discussion can invoke significant emotional turmoil. So before we continue to tacitly accept this shift in interviewing, it is important to consider its purpose and impact on those being interviewed.
I remember only one of my medical school interviews clearly. The interviewer shook my hand, told me his name, gestured at me to sit down and before I had even fully taken my seat, asked, “So, how did your brother die?” I had written about my brother’s death in a few of my essays where it seemed relevant — as a way to provide insight into my own experiences. In writing about it, I understood the implication that I consented to discuss the topic and, as such, I was able to answer his question with minimal hesitation. Nevertheless, the question itself and the way in which it was asked left me startled and uncomfortable with both the interviewer and the type of institution that would condone this interview style.
At the time, I interpreted the interviewer’s approach as a tactic, a method of testing my ability to respond and stay composed under stressful, potentially upsetting situations. I had been warned that some schools trained interviewers to ask stressful questions with this purpose in mind. The school in question accepted me, so I will assume that I passed that test. Nonetheless, I think the test itself is wildly inappropriate and indicative of the type of destructive culture that some still find acceptable in medicine. This same culture allows faculty and physicians to ask students why they want to go into a field like psychiatry or addiction medicine with a certain look, one which betrays the fact that they are hoping for a particularly graphic answer.
In my situation, one could argue that I consented to discuss the topic by including it in an essay; therefore, no matter how the topic was broached, I was obligated to engage. But it is important to recognize that one disclosure does not automatically permit the recipient to probe deeper. In a case of a sexual assault, for example, the disclosure of having been assaulted does not give the listener permission to ask for details of the assault. For most, this example seems obvious, but, when extended to other potentially traumatic situations, the point appears to be lost. Students who disclose their queer identity do not owe the listener details of how their family responded when they came out. Likewise, students who state that they spent their formative years in a war-torn country are not giving permission to be asked about the potential traumas they experienced while there.
The interviewer must consider the purpose of their questions and whether it is necessary to even broach certain topics. Some questions are asked either to “test” the applicant or satisfy the interviewer’s curiosity, neither of which are appropriate motivations. In those few cases where there may be a meaningful reason to address trauma, questions should be respectful and should not seek more detail than has already been provided. Because, ultimately, the person sharing that vulnerable information should make the decision on what and how much they want to share. Regardless of the situation or the power dynamic, details are never owed.
The examples above are largely situations in which the person has some degree of choice in whether trauma is disclosed; however, there are people whose traumatic experiences are immediately seen without any form of consent. Race, gender and many disabilities are often visible and assumed. Consequently, those folks already know how quickly assumptions are made and the negative implications that can result. Although there are laws restricting certain questions in medical school and residency interviews — particularly as they relate to marginalized identities — these laws do not prevent more insidious questions and assumptions that can be even more personal and painful.
While an interviewer cannot ask a student their ethnicity, for many students of color this is not something that can be hidden. Plus, interviewers are allowed to ask probing questions about how racism affects the applicant or even their thoughts on protests, such as those occurring now against police brutality. And, inevitably, when a Black student is asked about their thoughts on the current movement, it is not the same as when the question is asked to a White student. There is the unspoken “as a Black student…” that precedes the question and that forces the applicant to consider their own identity, community and traumas when responding.
For example, police violence is the leading cause of death for young Black Americans; the odds of a Black man dying at the hands of the police are 1 in 1,000. This real and constant threat results in deep-rooted trauma and fear that many Black Americans as well as other minority groups have to experience every day. So, forcing these distressing conversations onto vulnerable and already underrepresented students during an interview is unnecessary and, frankly, inhumane.
I recognize that interviews aim to gauge many aspects of applicants, including how they handle tough situations. But those questions can be answered without requiring students to re-experience and disclose traumas. Instead, ask applicants whether they have experienced difficulties with patients in clinics and how they handled them. That leaves the conversation open for the responder to also discuss more personal experiences if they feel comfortable doing so.
Ultimately, the legacy of medical training is rooted in the concept that students must be broken down and humiliated in order to learn effectively. We are just now beginning to recognize that this is not the best way to train healthy physicians, and there have been wide-reaching efforts to change this system. These changes must extend to the interview process. Interviews are fundamentally stressful, and there is an intrinsic power imbalance. We should not allow the use of this dynamic to force eager applicants to disclose issues and experiences that are inherently traumatizing. Because they do not owe you their trauma.
Image credit: Application – glasses – pen (CC BY-SA 2.0) by flazingo_photos
Contributing Writer
Wayne State University School of Medicine
Tabitha Moses is a fifth-year MD/PhD Candidate at Wayne State University School of Medicine. She grew up in England and moved to Baltimore to complete her B.A in Cognitive Science and Philosophy and M.S. in Biotechnology at Johns Hopkins University. She is passionate about policy and advocating for her patients. She is currently working on her PhD in Translational Neuroscience focusing on the effects of stress on people with opioid use disorder as well as working to improve addiction medicine education. After graduating medical school, she would like to pursue a career as a physician-scientist in addiction psychiatry.
