12 November 2009

Interpersonal skills

In a comment on my last post, faithful reader and frequent commenter Anonymous asked, "How do you get a good reading on interpersonal skills in a brief interview?"

That's a good question.  I suppose the simplest answer is, you don't, at least not in any sort of comprehensive way.  In some cases you can -- a person who is warm, engaging, and able to hold up their end of a lively conversation in an interview setting is always going to be near the top of my list.  But I make a lot of allowances for people in their interviews -- they are nervous, know they are being watched and judged, it is a high-stakes encounter for them, and most people are a lot more constrained in an interview than they are in their day-to-day lives.  I make the interview as informal as possible, bring a casual, conversational tone to the meeting and do everything I can to encourage them to open up and just chat.  We usually take them to lunch and see how they hold up in a more social setting.  (In one case we took a guy to a bar and filled him with beer before interviewing him -- but that was a special case.)  I typically spend three hours with a prospective candidate.  In most cases I get a sense of the sort of person they are, but many interviewees are still reserved enough that I come away with no clear sense of their interpersonal skills.

So we check references.  Thoroughly and exhaustively.

A lot of people have been surprised by this -- they say "well, everybody just picks references that like them so what are you ever going to learn from reference checking?"  To some degree that is true -- every residency director has a real interest in getting his residents jobs and they tend to give a positive appraisal of their trainees.  So you've got to work it.  The key here is to call all the references; don't just accept a letter of reference, and ask very detailed questions.  You start off letting the reference free-form about the candidate, which is usually positive.  But I follow up with a structured questionnaire which asks about their stress management skills, their relationship with the nursing staff, their frustration tolerance, their ability to make decisions, their ability to move the department, their strengths and their "areas for growth."  It's amazing how a general "Yeah, this guy is solid" reference can open up in details when you delve a little deeper.  Better yet, when one reference gives me a piece of information, I can cross-check that with the next and ask them to expand on it.  Also, having been doing this job for a few years, I have gotten to know some of the key referrers and have a relationship with them where they are more comfortable giving me frank insights into their residents.

The most valuable tool, however, it to check nursing references.  Nurses are startlingly candid and will usually give you the inside story on a candidate.   I ask all potential recruits to provide at least two nursing references.  Better yet, I call the nursing station at two AM and ask for the charge nurse.  The most accurate predictor of how well a doc does in our group is how they treat and get along with the nursing staff.  The clinical quality of most new residents is exceptional; they all seem to graduate with the essential knowledge base.  But those that can't understand that Emergency Medicine is a team sport, those that can't play nice in the sandbox, they are the ones that tend to flame out early in almost any practice setting.  The best reference I ever got was to call a nursing station and tell the charge nurse I was checking on Doc X. In an anguished voice, she exclaimed "You can't have him!"  Done -- hired.  (Yes, I ask permission before calling.)

None of this is fool-proof, of course, and references can always just lie to you.  For that reason I tend to prefer candidates who are referred by people I know (and especially those I work with) since those referrers put their credibility on the line and can be better trusted.   I swear by the process, though, since I have had more than a few people who looked fine on paper, and comported themselves well enough in their interview, and I was expecting to make them an offer.  After the reference check, however, there were red flags all over the place and we decided not to hire them.   However, I find that since most of the people who apply with us are good people, I do less as a detective to suss out the Bad Stuff, but rather to positively sort the candidates.  The references which are consistently glowing and full of superlatives rise to the top over those which are merely solid.

But Oh Boy is it a lot of work.   (BTW this entire post was composed while waiting for a reference to call me back.  Grr.)  It pays off in the end, though.  A bad hiring decision is very hard to undo.


  1. It never ceases to amaze me that people hire without checking references. What could they be thinking? Why bother asking for them if you're not going to check them?

  2. Why would a bad hiring position be very hard to undo? Is it because due to the all the investment you have placed on this new employee? Or it also looks bad on your part if you had to fire them?

  3. Thank-you so much for your well-placed confidence in nursing assessment. BTW, I would think it would work equally well for nurses to provide MD references (not that we really need any to get hired - usually a pulse and a license is sufficient).

  4. I think when interviewing you need to watch and see if the doc can talk and do something at the same time. Can he multitask.

    Set up a situation so he's doing something physical, I don't care how trivial, even if its washing his hands. Ask him a question and watch to see if he can talk and continue with the physical activity at the same time. Or take him to lunch in the hospital cafeteria. Is he able to manage a cafeteria tray and a conversation at the same time? Or does he stop what he's doing when he talks?

    People who can't talk and do shit at the same time, nurse or doc, have no business working in an ER.

  5. thanks for answering from me, anonymous. It sounds like you do a really thorough vetting process, certainly better than Obama. lol. Even though my political views are far different than yours it sounds like you run a really good ship


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