The COVID-19 pandemic disrupted the system of in-person residency recruitment, transforming the process to entirely virtual. In “Planning for Virtual Interviews: Residency Recruitment During a Pandemic” we described the effects of web-based interviews on communication and proposed best practices based on the limited literature available.1 Subsequently, three residency recruitment cycles have occurred virtually yielding relatively stable match rates.2 In this progress report, we discuss the published experience of virtual residency recruitment and consider the perspectives of both applicants and programs to help inform future recruitment cycles as we emerge from the public health emergency.
Applicant Perspectives
Applicants reported a significant reduction in both time and cost with virtual recruitment.3, 4, 5 For some, these savings allowed them to apply to more programs, thus improving equity and access in the application process.3 The majority of applicants felt they could adequately represent themselves in the virtual format by selecting unique backgrounds to showcase their personality or by staying on camera during recruitment mixers to express interest.4 Many medical schools implemented virtual readiness training to help students succeed which students found adequately prepared them.6 Applicants preferred the virtual format for the comfort and ease afforded by interviewing in a familiar space which reduced interview day stress and anxiety.4
Despite these positives, some applicants expressed difficulty assessing a program’s culture or the geographic area in a virtual setting.4, 5, 6 This may explain the finding in some specialties that applicants were more likely to match at their home institution than in prior years.7 Programmatic offerings such as live teaching sessions, virtual Happy-Hours and resident Q&A sessions were useful in assessing overall fit and resident wellbeing. Applicants also found programs’ social media presence helpful in determining program culture.
Program Perspectives
Programs also noted cost savings due to the elimination of hosting costs. The time implications for programs were not as clear. Many programs received increased applications, held more interviews, and spent significant efforts broadening their social media presence and updating online resources.8, 9 Many program directors have advocated for capping the number of program applications if virtual interviews continue to hasten this escalation.
Program directors reported that it was more difficult to assess fit, professionalism, and interpersonal skills in the virtual format.9 Therefore, they relied more heavily on the other application materials such as the Medical Student Performance Evaluation, letters of recommendation, and publications. This may have unintended equity implications. They also found it challenging to gauge an applicant’s interest in their program. All of this contributed to them finding it harder to create their rank lists.8 They also reported concerns about being able to recruit people who have never been to their location, particularly for programs outside of big cities.9 Despite these drawbacks, most program directors stated they would choose to participate in virtual interviews if they were optional.
Table 1.
Virtual Interviews: A Summary of Considerations.
| Advantages |
Challenges |
Considerations for Future |
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|---|---|---|---|---|---|
| Applicant | Program | Applicant | Program | Applicant | Program |
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Discussion
The significant cost and time savings and decreased carbon footprint of the virtual modality make a compelling argument to maintain the virtual setting for residency recruitment. However, concerns have been raised by applicants regarding their ability to assess a program’s culture and geographic area. In addition, program directors have expressed concerns about increasing applications as well as their ability to assess applicants in a virtual format. This raises the possibility of using a hybrid format that combines virtual interviews with an in-person component. There are pros and cons to this format as well, including continued considerations of cost and equitable opportunities for applicants, as well as program time investment and seasonal weather concerns.
As educators consider how to move forward, we must be mindful to avoid a two-tier system for applicants or programs. Formats where only some applicants come in person have the potential to introduce bias and worsen inequities if only those who can afford to travel interview in person. A potential format to minimize introducing bias is to have virtual interviews and holistic reviews determine program ranking decisions. Subsequently, applicants could choose to attend an optional, in-person second-look experience to visit the program as part of their ranking process to see the area, meet people, and assess the culture of the program with no assessment of the applicants. This would require that programs submit their rank lists prior to applicants attending second looks to reduce the risk of programs biasing towards those who visited. There is also a risk of programs being disadvantaged in a hybrid system. Particularly, smaller programs with less resources to host a second look and programs in less commonly visited locations may have a harder time recruiting.
The residency recruitment process has become increasingly complex. While an in-depth discussion about the residency recruitment processes is beyond the scope of this paper, the decisions around recruitment format must be made in the context of the overall process. There has been movement towards more holistic reviews of applicants, in part because of the trend towards pass/fail metrics that make differentiation of student performance harder. In 2020, the American Association of Medical Colleges developed the supplemental Electronic Residency Application Service application to facilitate the holistic review process by allowing applicants to share more details about themselves and highlight particular experiences.10 This holistic view of an applicant deemphasizes United States Medical Licensing Examination scores and may decrease bias and inequities. At the same time, applicants find the process stressful, and competition is perceived as fierce, leading to increasing numbers of applications. The increased number of applications paired with the holistic review process creates increased time demands on programs. Some specialties have introduced signaling, as a way for applicants to indicate their “genuine interest” to a limited number of programs at the time of application to help programs focus their time.10
The ideal residency recruitment system may be different for different specialties but should be uniform within each specialty to best meet the needs of applicants and programs. By necessity, the processes of residency recruitment changed drastically over the past three years. We now have the responsibility to identify and maintain the best aspects of these changes to improve recruitment for both applicants and programs going forward.
Funding Source
None
Disclosure of interest
The authors report no conflict of interest
Declaration of interest
none
Abbreviations
none
Declaration of Competing Interest
none
References
- 1.Wolff M., Burrows H. Planning for Virtual Interviews: Residency Recruitment During a Pandemic. Academic Pediatrics. 2021;21(1):24–31. doi: 10.1016/j.acap.2020.10.006. Jan-Feb. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.National Resident Matching Program . National Residency Match Program; Washington, DC, USA: 2022. Results and Data: 2022 Main Residency Match®.〈https://www.nrmp.org/wp-content/uploads/2022/11/2022-Main-Match-Results-and-Data-Final-Revised.pdf〉 Accessed May 2, 2023. [Google Scholar]
- 3.National Resident Matching Program, 2021 Applicant and Program Director Survey Findings: Impact of the Virtual Experience on the Transition to Residency Research Brief. 〈https://www.nrmp.org/wp-content/uploads/2021/08/Research-Brief-Virtual-Experience-2021-FINAL.pdf〉 Accessed: May 1, 2023
- 4.Ding J.J., Has P., Hampton B.S., et al. Obstetrics and gynecology resident perception of virtual fellowship interviews. BMC Med Educ. 2022;22(1):58. doi: 10.1186/s12909-022-03113-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Lee E., Terhaar S., Shakhtour L., et al. Virtual residency interviews during the COVID-19 pandemic: the applicant's perspective. South Med J. 2022;115(9):698–706. doi: 10.14423/SMJ.0000000000001442. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Huppert L.A., Hsiao E.C., Cho K.C., et al. Virtual interviews at graduate medical education training programs: determining evidence-based best practices. Acad Med. 2021;96(8):1137–1145. doi: 10.1097/ACM.0000000000003868. [DOI] [PubMed] [Google Scholar]
- 7.Abdelwahab R., Antezana L.A., Xie K.Z., et al. Cross-sectional study of dermatology residency home match incidence during the COVID-19 pandemic. J Am Acad Dermatol. 2021;87:886–888. doi: 10.1016/j.jaad.2021.12.004. 〈https://www.ncbi.nlm〉 nih.gov/pubmed/34921983.] [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Ream M., Thompson-Stone R. Virtual Residency Interview Experience: The Child Neurology Residency Program Perspective. Pediatric Neurology. 2022;126:3–8. doi: 10.1016/j.pediatrneurol.2021.09.016. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Ponterio J., Levy L., Lakhi N. Evaluation of the Virtual Interview Format for Resident Recruitment as a Result of COVID-19 Restrictions: Residency Program Directors’ Perspectives. Acad Med. 2022;97:1360–1367. doi: 10.1097/ACM.0000000000004730. [DOI] [PubMed] [Google Scholar]
- 10.2024 ERAS Application Season Program Signaling. 〈https://connect.aamc.org/resourcelibraries/2024erasprogramsignaling〉. Accessed: May 4, 2023