---
name: executive-interview-prep
description: >
  Prepare for executive-level interviews — CMO, Head of Clinical Development, SVP, Chief
  Medical Officer at startups, scale-ups, and growth-stage biotechs. Cover the canonical
  executive interview elements — strategic thinking, P&L judgment, leadership scenarios,
  "first 90 days" plans, and board-readiness. Reference when prepping for any executive
  loop, building a 100-day plan presentation, or rehearsing leadership-scenario answers.
metadata:
  author: nirav
  version: "1.0"
compatibility: Designed for Claude Code
allowed-tools: Read
---

# Executive Interview Prep — Where Operating Judgment Is the Test

Executive interviews — for CMO, Head of Clin Dev, SVP, or equivalent roles — test something different from VC interviews: not "do you have a thesis," but "can you run something." The judgment under test is operational: how you'll prioritize the first quarter, how you'll handle the inherited team, how you'll manage the board, how you'll allocate capital across competing programs. Senior MDs frequently underestimate this layer; they over-prepare on clinical depth (which they have) and under-prepare on operating judgment (which they need to articulate).

## Key Concepts

### The Canonical Executive Interview Loop

| Round | What's Tested | Typical Format |
|---|---|---|
| **CEO conversation** | Trust, fit, strategic chemistry | 60–90 min |
| **Board / chair conversation** | Governance literacy, board-management | 45–60 min |
| **Existing team panel** | Team-fit, collaboration patterns | 60 min |
| **Strategic / scenario** | "How would you handle X?" | 60–90 min |
| **100-day plan presentation** | Sometimes formal, sometimes informal | 60–90 min |
| **Reference round** | What does the network say | Backchannel |

### What Senior Executive Interviewers Test

1. **Strategic clarity** — Can you name the few highest-leverage decisions and why?
2. **Operating judgment** — Will you make the right tradeoffs under capital and time constraint?
3. **Team-building** — Can you recruit, retain, and develop the team you'll inherit?
4. **Board management** — Can you communicate up to a board without burning trust?
5. **Crisis instinct** — How do you behave when things go wrong?
6. **Cultural fit** — Will you thrive at this stage of company?
7. **Domain depth** — In MD-track exec roles, deep clinical/regulatory mastery is expected and tested

### The 100-Day Plan

Most senior executive interviews include a "what would your first 90 days look like" question, and many ask for a formal 100-day plan presentation. The strong plan has three phases:

**Phase 1: Listen (Days 1–30)** — Deliberate listening. 1:1s with every direct report and every board member. Read every recent board deck. Talk to 3–5 customers/stakeholders. Audit the pipeline (or whatever the org's primary asset). Don't promise.

**Phase 2: Diagnose (Days 31–60)** — Frame what you've learned. Identify the 3 highest-leverage interventions. Test the diagnoses with the CEO and board. Begin building the team strategy.

**Phase 3: Commit (Days 61–100)** — Make a small number of crisp commitments. Communicate them up (board) and down (team). Run early wins. Set up the operating cadence.

### The Strategic-Scenario Answer Structure

When asked "how would you handle X" (e.g., "the trial is going to miss its primary endpoint"):

1. **Name the stakes** — financial, regulatory, team, board
2. **Identify the few decisions that matter** — go/no-go, restructure, pivot
3. **Walk the decision logic** — what data, what analysis, what stakeholder conversations
4. **Name the kill criteria** — what would make you say stop, what would make you say continue
5. **Communicate decision** — how you'd announce internally and externally

This structure reads as senior because it foregrounds decision-quality reasoning, not tactical fixes.

### Common Failure Modes

| Failure | Looks Like | Fix |
|---|---|---|
| Over-clinical | Clinical solutions to operating problems | Surface the operating tradeoffs, not just the science |
| No 100-day plan | "I'd want to see what's there before I plan" | Have a structured plan even if you'll modify on contact |
| Wishful operator | "I'd build a great team" | Be specific — who, when, what gaps |
| Board-naive | Doesn't understand board cadence or dynamics | Demonstrate you've thought about board management |
| No P&L sense | Avoids questions about cost/capital | Have a view, even if the numbers will be wrong |

### Board-Adjacent Considerations

For CMO/SVP/Head-of roles at venture-backed companies, the candidate will work directly with the board. Senior interviewers test this. Useful preparation:

- Understand the board composition (which VCs, what stage, prior board service)
- Read the firm's recent partner essays
- Have a view on what the board's priorities will be in the next 12 months
- Be ready to discuss how you'd handle a board disagreement on a major decision

## Self-Coaching Track

**For your situation (MD → biotech operator/CMO track):**

1. **Build the 100-day plan template.** Even before any specific role, draft a generic 100-day plan template you can quickly tune to a specific company. Include the three phases above.

2. **Per company, tune the 100-day plan.** When you have a specific company interviewing you, tune the plan with company-specifics: what you've learned about their pipeline, team, board, recent challenges.

3. **Build 5 strategic-scenario answers.** Common scenarios in biotech CMO interviews: missed endpoint, FDA rejection, team conflict, board disagreement, capital crunch. Have a structured answer ready for each.

4. **Refresh your board literacy.** If you haven't worked directly with VC-stage boards, prep on board cadence, board-deck culture, IC dynamics. Cross-load with `executive-presence/board-readiness`.

5. **Prepare your "why this company, why this stage" answer.** Companies hire executives expecting a fit with their stage. Be specific about why you're the right CMO for *this* stage of *this* company.

6. **Reference round audit.** Same as VC prep — make sure your network references are warmed up. Ex-managers, ex-board members, ex-collaborators.

## Teach / Mentor-Others Track

**When coaching a junior or peer through executive interview prep:**

1. **Diagnose 100-day-plan readiness.** Most mentees don't have one ready. Insist on a draft before any specific company is in play.

2. **Force the operating-vs-clinical reframe.** Many MD mentees default to clinical-solution mode. Coach them to reframe: even when the question is clinical, surface the operating tradeoffs (cost, timeline, team, board).

3. **The board-management answer is undertrained.** Most mentees haven't worked closely with a VC board. Have them read 3 board decks (publicly available or anonymized) before any board-adjacent interview.

4. **Strategic-scenario rehearsal is high-leverage.** Walk through 3–5 scenarios with the mentee. The answer structure (stakes, decisions, logic, kill criteria, communication) is durable.

5. **Coach against false certainty.** Some mentees, hearing "be decisive," over-commit in answers. Reframe: certainty without the supporting reasoning is junior; structured uncertainty with crisp decisions is senior.

6. **Reference round prep is often skipped.** Coach mentees to deliberately think about who'll be called and warm them up.

## When This Applies

- Preparing for any executive loop (CMO, Head of Clin Dev, SVP)
- Building or refreshing the 100-day plan template
- Per-company tuning before specific interviews
- Strategic-scenario rehearsal
- Post-loop debrief

## Cross-Domain Connections

- **executive-presence/board-readiness** — Board management literacy
- **executive-presence/executive-communication** — 100-day plan presentations and board materials
- **interview-mastery/behavioral-frameworks** — Behavioral and team-fit rounds
- **interview-mastery/domain-deepdives** — Clinical-depth rounds in CMO interviews
- **interview-mastery/panel-and-case** — Multi-interviewer panels are common at exec level
- **biotech-venture/asclepius** — Source of clinical strategy substance
- **personal-positioning/credibility-translation** — Translating exec-level credibility for the audience
- **trajectory-design/role-archetype-mapping** — Understanding what each exec archetype actually does