Clinical Internship Prep!

As the new wave of anxiety rides over the next year's clinical internship matching class, I want to share some of my experiences with the process. In an attempt to avoid my survivorship-biased responses to internship tips, I tried to write the majority of these notes during the process of applications and interviewing (rather than after I matched).

My husband and I applied to internship the same year, which added a whole new layer of uncertainty to what our lives would like like the following year. We successfully couple's matched and we are currently finishing our internship year (2020) at University of Washington School of Medicine. My husband is the Behavioral Medicine track and I am in the Child track.

Disclaimer: Clinical internship prep is a very individualized process, despite the standardized application materials. Nevertheless, we found ourselves desperately seeking input from anyone that had or knew of those that had done couple's matching, as tangentially related as it may be to our experience. In that spirit, here is what we learned. Hopefully this information is also helpful, even if you aren't couple's matching!

It's a bit long, so a guidepost, this blog post is roughly organized by:

• Background (for a reference point to where we are coming from)
• Picking Programs & Materials
  • Beyond your hours (what else matters)
  • Misc Tips for prepping materials
• Travel Tips
• Few Interview Tips
• Few more couples matching-specific notes
• Parting Notes

Of course this advice is not a one size fits all; therefore, I tried to give as much info as to what program I wanted and where I was coming from.

1) Where was I applying and why?

1a. Concentration

I applied to child, early adversity, peds neuropsych and/or peds assessment tracks.

1b. Type of places I applied

Academic Medical Centers /Hospitals

1c. My long-term goal/background going into internship

My goal is tenure track at R1 research institute OR academic medical center (with mix of research and clinical work)—heavier on research.

1d. Type of program/training I came from

University of Oregon, Clinical PhD. This is important because our program emphasized research and the science-practitioner model. The majority of people in our program our year and prior years applied their 6th year (versus applying 4th to 5th year as more clinically focused programs tend to do).

2) We did couple's matching.

This means we picked locations and programs that were a good fit for both of us.

My husband applied to similar places (academic medical centers/hospitals) and has similar long-term goals (tenure track or academic medical center), but he applied to a mixture of pediatric neuropsych and adult tracks. This meant we usually weren't competing for the same "spot", but it also meant some places were great child or adult, but didn't have a great fit for the other one of us.

3) We were location-restricted.

In case couple's matching didn't make it tricker, we made personal boundaries about what we were willing to do or where we were willing to live. We also have 2 fairly large dogs, which came into consideration more than you may expect! We only applied to 4 general regions (West Coast/PNW, Boston area, Pittsburgh, PA area, and then ~2 other specific sites outside of those areas). This made the search faster, but the temptation higher to stretch our interests to some programs.

• There are tons of resources online from APPIC and the magic "APAGS Internships in Psychology book." We looked at all of that and found that advice very helpful! These are some additional tips that worked for me that were either not discussed in those resources, or I want to further highlight as helpful.
• Discover your story. Start thinking about your "story" pretty early. I started thinking about my story in the spring (wasn't writing yet though!). How do things tie together for you? How you want to represent yourself? By the time I actually started writing, I had thought about these topics a lot and it made the writing kind of fun (wrote that note during the process!). Survivorship bias note: On the other side of this, I'm so grateful I forced myself to do this thoughtfully. It continues to serve my clinical-research identity. 
• Get a feel for your options. I started to look at schools in the spring and reached out to people that previously did similar tracks to what I was interested in to see where they applied. It helped get a good sense of what schools should be on my radar. I started looking this early because we wanted to know what options we had as a couple. 
  • Keep an excel sheet of all these details as you look them up or you *will* waste hours relooking things up or mixing information up about schools.
    • Specifically take note of what they are looking for and their average hours—it may be different than the number of recommended hours from your program. Know the hours you need for your goal program and shoot for that. 
• Talk to lots of people! Seek advice from as many people as you can that have gone through this process, inside and outside of your specific program, especially for people that did programs similar to what you want to do. They can help prepare you and also give you some inside scoop on programs before you decide to apply. For example, some of my best resources were colleagues I reached out to from other programs. 
• Have lots of readers! Coming from a research heavier background, I think of this like grants. My most successful applications have been ones that not only had lots of eyes on it, but also had eyes on it from people that weren't too close to the material. I asked colleagues outside of clinical and outside of my program to read my essays and my (template) cover letter. I am forever grateful for their time and advice! 
• Don't apply to safety schools! This is passed down every year and anxiety about matching inevitably gets people to apply to "a few more." This was tough with couple's matching. We wanted to maximize spots in the same city and would try to extend fit. This is a personal decision, of course. For us in the end, we realized if it was that hard to write the cover letter or we weren't excited reading the program materials, it wasn't worth it and we scratched the application. If you don't see a good fit, they won't either. OR worse, you spend the time and money to go to the interview, only to reinforce you would not be happy there (this happened to us too). General rule of thumb-- if you have a hard time writing the fit in your cover letter, don't apply! It will save you soo much money and time! 
• Just one year!  I've heard this advice go both ways. I understand if you want to treat this as a one year thing that doesn’t matter. It’s super adaptive to do that for many reasons. If you don't get your top choice, or it's an odd location, it's not the end of the world. It really is just one year. You've made it through the hardest part. This won't make or break your career. 
  • ...Or make it more! Alternatively, I actually found it helpful to think of it as a launching pad beyond one year. It was exciting to look at places and see if I could see a future there. I picked places that I would like to either postdoc or even be faculty. I also looked for opportunities that I thought could make me uniquely competitive for my next steps (e.g., for me, GI rotations)! Survivorship bias note: I am ending my internship year soon and I see my internship year as influencing my career trajectory and it made a big impact on me. 
• Contact research mentors ahead of time (pro/cons). I was warned about pros and cons of contacting mentors ahead of time and it's something I think you'll have to judge on a case-by-case basis. At research heavy sites, I contacted faculty ahead of time about research fit. Some places even suggested it. On the other hand, this is your clinical year, so I was warned this could harm my application. I personally don't regret doing this. I’m still in contact with several of those people across the US! In other words, some of my interviews served as pre postdoc interviews or at least getting my face and name out to some of these places. I’ve also stayed in touch and reached out to interns and have had interns reach out to me from places I didn’t match.

I touched on this with your "story" but it's so important. I know there was a large focus on hours for internships and I understand the stress around those numbers.

• Pay attention to your break down of hours for fit versus overall hours. Your gross number of hours alone isn’t what matters, but rather what is most important is the break down of those hours for what you want to do. For example, if you are applying to peds neuro, your assessment hours need to be much higher than if you are applying to an intervention site. 
• Be strategic with your time. I did not hit my hours by stressing about my hours. I was strategic with my time; I chose placements that I got the most bang for my buck in the ratio of face-to-face to indirect hours. For example, I loved my kiddos and chose to stay with them through adoption or placement back to biological parent transitions, which meant I stayed at a practicum longer than planned. I also ended up loving assessment and particularly wanting to keep working with one supervisor, so I kept doing 1 day a week because I enjoyed it. Don’t stress or push yourself for more hours if you aren’t enjoying it. You won’t like the places that require that of you anyway. 
• You as a package matters more than total hours. Think of hours as a minimum to get your name in front of them (which varies site to site) and after that it’s about YOU and your fit. More hours beyond that won’t make you more competitive. You as a package will! This was advice passed to me and I want to pass it on to you.

• Choose letters of recommendation wisely. Programs seem to really read and care about these! I had my letters mentioned in interviews and even quoted in one interview. 
• Make your essays unique. I said this above, but it bears repeating. Take the time to craft your story here and make these unique. How hard this is to do varies by individual, but it will serve you beyond applications. I can say I wasn't someone with a clear clinical work and research link. I had to lay out my argument. Several programs commented on my essays during the interview.
  • Spend the time to try to tell a cohesive story between research, clinical, and where you want to go. 
  • Bonus points if you can make it super clear how their program is that obvious bridge to your next steps.
• Research (can) matter. If you are applying to research sites, they actually do care about your research and want forward thinkers. Your publications and dissertation will be a big topic of discussion. I actually found these conversations to be a fun area of reprieve during interviews. I was in my comfort zone.

Again, my travel advice is based on an already location-restricted application, which makes it easier than for folks that are applying more broadly.

• I drew a large calendar on a piece of paper. I then put each school I applied to on a separate post it. Next, I moved around my post its for each school’s potential dates on the calendar and planned my ideal January (before I knew if would get a single interview!).
  • It serves as a way to buy you time and feel like you have control when you are waiting for interview invitations. I am so happy I did this early, because it made picking dates as soon as I got an email really easy. And respond as soon as you can! The spot may be taken.
  • There were some schools I had to turn down due to scheduling conflicts/ couples matching mismatch (didn't receive interview in the same location). Do this gracefully as it’s a small world and everyone may still be a future colleague one day. Plan (as much as you possibly can) which site would be lower priority if you have a conflict.
• I didn’t book travel until I knew all the places I would go. I booked one way between cities and whenever possible stayed with family to cut expenses.
  • I made sure to book direct. Yes, this may cost more, but you will be SO tired and don't need extra stress of a missed layover... It was one of my best decisions. 
  • For my schedule this meant not being back in Eugene (small airport) for the month of January. This also helped cost, because Eugene is expensive to fly out of! If you live in a bigger city, this may not be a factor.
  • You can fly out the night of an interview. I thought that would be stressful, but I actually wish I did that more over the early flight the next morning. You won't be productive that evening anyway, so try to book that evening, if possible. 
  • AVOID 6am flight from East to West Coast!! It was fine West-East, but was awful the other direction. This was the one thing I highly regretted in my travel planning and vowed to share with everyone so that no one makes my mistake again.
  • I didn’t have credit card miles or perks—this was recommended to us and I recommend it to others! I think that’s a great way to cut costs as well. Just make sure to pay your card off in full each month. That way you will build credit and save on travel expenses.
  • If a place offers a Dec date- take it!! 
  • I also was able to clump the majority of interviews on the West and East coast, making my average flight under $100 and then just a few more expensive flights. I know this is NOT the case for a lot of folks. I attribute this to 1) location restriction in the first place and 2) I spent a long time on my "post-it calendar" to make this work.
• Don’t go anywhere you wouldn’t be willing to actually live!

• You are qualified! Now it's fit. The majority of sites made it explicit that if you got an interview you were qualified; it was now about fit. Therefore, many interviews were actually trying to sell applicants on why we would love it there and seeing what questions they could help answer.
• I know I didn't I answered every question perfectly (or close to perfectly). Expecting you will be perfect, however, will set you up to fail. I think my saving grace as an "imperfect interviewee" was that I focused on building a connection with the person who was interviewing me and staying present and excited.
  • I think the positive feedback in response to my thank you emails had less to do with my answers during the interview and more to do with shared connection and enthusiasm. 
• Take notes, video recordings, voice recordings, or debrief with the same person after each interview. It was easy for me to leave most places as the "next favorite"—but it was helpful to talk to my sister who reminded me of the difference in my excitement at different places right after.
• By my first interview, I had prepped for all the types of questions I wanted to know—this initial prep was the longest (too long). After that, I prepped for interviews at each school the night before by reviewing the school info and specific people I’d be interviewing with (if provided). This let me make site specific questions. To be perfectly honest, I got sloppier in this prep as time went on and it didn’t seem to impact me—so I was probably over-preparing at first. You will also start to refine your answers the more you say them, so each interview is prep for the next.
• Tough questions? Show your thought process. Some schools had more formal scenarios, but in my experience, that was the minority. There will still be questions that could come up that stump you or a clinical presentation you haven't encountered. The best advice I got for tough questions was to show your thought process. For example, "I’ve never worked with someone with diabetes before, but I’ve worked with complex medical and co-morbid mental health in neuropsych... based on that experience, the type of questions I'd be thinking about are..." It (appeared) people were happy with those answers.
• Make friends! I loved meeting other people on the interviews. Relatedly, the more relaxed you are, the better you present and the process can actually be really fun! I noted this DURING the process to make sure I wasn’t biased by the outcome.
• Send thoughtful thank you emails. A generic thank you won’t get you very far, but use it as a time to reconnect and remind them of your conversation. 

A few last notes about couple's matching.

Logistically, you state you are couple's matching during the application phase and sync your application number with the other person. However, It was not clear all schools we interviewed at together knew we were part of a couple's match. Our understanding is that we were both assessed individually for interviews. We made site-specific decisions around disclosing if we were couple's matching.

Logistically for ranking, you will both rank your top choices. Prior to submitting, APPIC will then spit out a combination of every one of those combinations in an excel sheet. You can then decide to delete any combinations you aren't willing to take. We went back and forth with this decision because the unknown can feel paralyzing, but in the end, we did not rank combinations we would not be willing to take (e.g., a West Coast- East Coast match). However, on the morning we received the phone call from our program director, it did not appear he knew he was calling to congratulate two people in the same house.

Again, gather advice from as many sources as you can. This is not a one-size fits all experience. This can be an incredibly stressful time filled with so much uncertainty, made even harder with the current state (COVID-19 pandemic). If you are feeling overwhelmed, finically burdened, or find this whole process archaic, you are not alone. Hopefully we see massive changes in how the internship process is constructed in the years to come.

You Got This!