Interviewer: Our guest today is Dr.Mirko Gilardino, the program director of the Plastic Surgery Program at McGill University. Dr.Gilardino, we welcome you as a guest in our website.


Dr.Gilardino: Thank you.


I: Could you tell us about yourself?


Dr.G: Sure, I am a board certified plastic surgeon. I did my training at McGill and a little bit at the University of Toronto. I did my fellowship training in craniofacial surgery at the University of Pennsylvania and the Children’s Hospital of Philadelphia. I serve currently as the Director of the Plastic Surgery Program at McGill and the Director of the H.B Williams Craniofacial and Cleft Unit at the Montreal Children’s Hospital.


I: Could you tell us about the selection process for the Middle Eastern candidates for the Plastic Surgery Program?


Dr.G: Sure, I think the major criteria for all of our pools are similar. You know we have a CARMS pool for our Canadian graduates. We have a pool for General Surgery graduates who are Americans and applying for plastic surgery fellowships and of course we have an international pool as the one you are asking about. The reason I mentioned this is that we look for similar track records of academic excellence. We look for clinical experience in the field of plastic surgery either in the form of electives or observerships. We also look for good letters of recommendations. Ideally what we are looking for is someone who is going to be an excellent surgeon – this generally comes in the form of high grades and research experience and publications. Obviously a background in research is useful and the ability of the resident to spend some time doing a Master’s improving their strength in academic plastic surgery is something that is a strong attribute for an applicant.


I: You mentioned clinical experience, how much minimum clinical experience are you looking for in a candidate?


Dr.G: My personal preference and that of our selection committee is that we tend to prefer applicants who already entered plastic surgery training back home, in the country where they are from. Part of this is it proves to me that they are successful enough to enter into a competitive environment back home. And also they have some back ground training so they spent a year or two doing plastic surgery and they know for sure that this is what they want to do. It is very difficult for us based on transcripts and letters of recommendations to tease out who the most superior applicants are, because it is just a different process for us than it is here in Canada. So, although it is not a prerequisite to be a resident in a plastic surgery program from wherever the applicant is coming from, it is certainly an advantage.


I: What about electives?


Dr.G: Absolutely! I am pretty confident that nobody has been selected in the last five or six years that has not spent some time with us in the form of an elective. Doing an elective is really important for the applicant to meet the faculty and get a feeling if McGill is the place where they are interested to train. On top of that, for us to get a feeling for, number one the clinical skill level, number two obviously the level of intelligence and background knowledge and importantly the communication skills. You are coming from a language base where you were training in a different language. It is important for us that applicants have a strong command of English and possess solid communication skills.


I: You mentioned the research experience. Some people think of going through either of two paths: doing a long period of clinical experience or having clinical experience then starting to do research. Which one do you recommend?


Dr.G: I think either is fine, however, doing research before applying (ex. a Master’s degree) allows the admissions committee and the faculty to get to know applicants in more depth. From purely a selection process standpoint, this is probably the best way to do it.


I: Is there is a preference to master’s or is it enough to do research?


Dr.G: Look, I think certainly some research is better than no research. If I have a choice, I would always favour someone who has dedicated the time to a Master’s degree.


I: Ok, I will go to another topic, most of the Middle Eastern candidates speak English as their second language. Do you think that speaking French language would add to the candidate?


Dr.G: Listen, when I meet the applicants in the interview process which happens six months before starting the program, I tell them: if you want to have the most out of your training, you got to pick up a little bit of the language, because if not, you are going to miss a lot. Certainly you can function with English only, many of our residents, not only form the Middle East function that way, but if you ask me, it is an opportunity. It is an opportunity to speak an interesting language that is spoken in a huge part of the world and you are going to gain more from your residency. So, yes, it is an advantage, there is no question about it.


I: So you think it would give the candidate an edge in the interview?


Dr.G: Certainly if a candidate comes to the interview and he already took French classes I would think that this would be a sign of proactive thinking of where they want to be and especially demonstrate that they would like to be here. Yes of course, is it a prerequisite? No. Is it an advantage? Yes.


I: Based on my understanding, some programs use the CV and recommendations as selection tools for the interview. Then selection depends on the performance in the interview. Does this apply to your program?


Dr.G: Well, a lot of decisions are even made before the interview process because what I can tell you is, occasionally we are very impressed with an applicant during the interview process. Meaning, you have an applicant who you have never met before, and he or she is quite impressive in the interview process. But that is a rarity. Most often we have an applicant or two who had done an elective with us, we really liked that person, we found him professional, mature, above level knowledge, all of those sort of things. As long as their interview is on par with that experience we had – this is what seals the deal. What you do not want is someone who did well in the elective then was a disaster in the interview. So the interview for us generally helps to solidify our opinion about a candidate.


I: Some applicants postpone their application for a year or more because they want to work on their CV then apply. Some programs do not like the candidates multiple times. Does this apply to your program?


Dr.G: Yes, a 100 %, your best shot is always your first shot! If you apply when you are not ready and it does not work out for you, and you apply again – you are at a disadvantage compared to someone who had a solid application and applied once. So I agree with you in a sense that it is not preferential for us to see someone for three or four years in a row.


I:So let’s take this further, I worked the best I could, and applied and I did not get accepted. What do think I should do, apply again? Work on my CV, take feedback from the program director?


Dr.G: Generally speaking, I think that getting some feed back on why you were not accepted is reasonable thing to do. Most of the times you will find people who did not have any research and pursue a Masters before applying again.


I: Does it make a difference for you when someone applies for different programs? Some people think, I want plastic surgery but as you said it is a very competitive program so I am going to apply for general surgery as a back up?


Dr.G: No, it certainly does not bother you when someone applies for example for a plastic surgery and then applies to general surgery as a back up. Traditionally, that is the way plastic surgeons were trained. What I think is a problem is when an applicant is “specialty shopping” or applying to multiple specialties. I would be careful not to apply to things that are not complementary per say, even though I understand that plastics is the most competitive field between the specialties to get to, I think they have to commit to it.



I: Is there anything else you would like to add?


Dr.G: We look at the grades; we definitely look at the letters especially from our old graduates as they are guys and girls we know and trained so those letters are important. The level of knowledge is very different between applicants. Sometimes we have applicants who have I would say a minimum knowledge base in plastic surgery and another time you have applicant who are very well-read. It is not about making sure that everybody knows you are smart, certainly if you are well-read people figure it out very quickly because they realize you have basic answers for basic questions. In the operating room you have an intelligent question base. You know the anatomy well. Nobody expects you to be a chief resident but we expect you to have gone through the process of reading ahead of time.


I: I have few questions; and in fact I have been asked these questions many times: Does the GPA and MCCEE scores make a difference in the selection process? Is there is a cut off value?


Dr.G: Yes, we look for sure at the GPA and the MCCEE scores and I will tell you why. Because the applicants are coming form a pool where we have a less control over and a less ability to understand how they did in medical school. First of all, I frequently ask one of our chief residents who is a Middle Eastern or an international to sit with us in the interview because it gives that person the ability to help us in the selection process. They know a little bit more about the system there and how it works. So this is one thing that is useful. Now for the grades that you asked about, numerical scores are important because that is an absolute. Every Canadian, every international has to take these exams. So for us, you know I look for a base line score I like to see people above that, because to me, at the end of day, getting in the program is one thing, but for me you have to pass your Royal College exams. And people who passed board exams are people who inevitably did well in tests. There no cut off value but I like to see scores above a certain average. Let us say for GPAs, I expect to see a GPA as high as possible. I expect from people who apply to plastic surgery to have high GPAs.


I: Sure, but let us say that God forbids my GPA and MCCEE scores are not very high. Would this mean that I have no chance getting accepted in plastic surgery?


Dr.G: No. But if it came down to two applicants that have exactly the same thing that will help us make the decision. But usually what happens at the end of the day, if you have a high score and we had another person who had a higher score but we did not like him. He was not good clinically for example or was arrogant or not communicative or rough with patient, I can tell you where we are going to go.


I: What about the USMLE scores? Do they make a difference?


Dr.G: The USMLE is another test for us. I think we can apply the same rule here. Generally speaking, somebody who did very well in the MCCEEs is somebody who is going to do very well in the USMLEs. And we look at those as one of our criteria. For me, as long as I see a reasonable GPA, what I do not want to see is someone who has got a great MCCEE score and then a GPA of 2.5. Because that means then you were not committed when you needed to be committed. Now they are focusing but they were not focusing at some stage. I would rather see a general consensus among the scores. I will ignore one bad score obviously! You can have a bad day.


I: Is there is any message that you want to deliver?


Dr.G: The recommendation letters, and I know by doing this over the years, they are inevitably similar. They all say this is a “good applicant”. The recommendation letters should be ideally very pointed and focused. In my mind, I would like to see for example: This is one of the top three students that I have seen this year, that rotated in the plastic surgery service or this is a resident in our program who is excelling and doing this sort of thing or that sort of thing. The letters that we get tend to be very generic and probably because they do not know the person very well or they have many letters to write, because they do not want to get into trouble – I understand that. It would be very useful for me to know: where did this person rank in this year, this is one of our top five persons this year. That would help us a lot.


I: Thank you very much Dr.Gilardino for accommodating us within your busy schedule.


Dr.G: You are welcome!

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