The COVID-19 Pandemic and Virtual Interviews in the 2020-2021 Resident Match

The coronavirus-19 (COVID-19) pandemic imposed social distancing and limitations on travel that profoundly affected the resident selection processes of American general surgical postgraduate training programs. Traditionally candidates underwent in-person visits at training hospital sites, interviewed with attending staff and resident trainees and toured the facility. Often the visits included an overnight stay to host interviewees at a social event such as a local restaurant. Applicants could visit the surrounding community to get an idea whether it would be a place where they could live.

With travel restrictions, many programs planned to conduct interviews using video technology.^1-3 Less clear is how the programs would provide the less formal aspects of the recruitment visit, such as meeting other residents and visiting the community. Therefore, a sample of general surgery residency program directors (PDs) were surveyed both before (July-August 2020) and after (March-April 2021) interview season regarding their use of telecommunications for during the 2020-2021 recruitment cycle.

We surveyed 13 medium-sized community teaching and university programs (4-7 residents/year) across the US, chosen on the basis of residency size and previous collaborations on other projects. PDs answered an 18-question multiple choice and multiple selection survey with the ability to provide additional comments, distributed prior to the start of the interview season for the 2020-2021 Match cycle. The same PDs were then given a follow-up three-question short answer survey after the completion of the Match cycle. This study was deemed exempt by our institutional review board.

Prior to interview season, all 13 PDs (100% response rate) planned virtual interviews, with more than three-fourths (76.9%, 10/13) planning to rely on them exclusively for their interactions with their candidates. Three (23.1%) were also asking for an in-person visit. Most of the respondents (61.5%, 8/13) planned to increase the number of interviews per position because of an expected increase in applicants. In the postinterview survey, 12 of the original 13 PDs responded (92.3% response rate). No program conducted in-person interviews, some citing the ACGME mandates. Each program used a web-based video chat system, spending an average of 15 minutes/interview. Most programs had candidates interview with the PD, at least one faculty member and one resident. Half of the PDs (6/12) reported no technical issues while the other half reported only minimal glitches. Of those reporting technical issues, no interview required rescheduling.

Facing the challenge of a new interview environment, one PD provided training in virtual interviewing for both the faculty and the candidates. In four programs (30.8%) only the faculty underwent training. Most of the residencies (61.5%, 8/13) made no special preparation for virtual interviews for either their faculty or candidates.

The PDs envisioned many problems with virtual interviews, including an inability to assess the candidates’ demeanor and mannerisms (84.6%, 11/13), technological glitches (76.9%, 10/13), and problems with connecting with the applicants on a professional level (61.5%, 8/13).

All PDs (100%, 13/13) were concerned that candidates might fail to connect with faculty during the virtual interview. They were also concerned that without in-person visits, candidates would not be able to have meaningful interactions with the current residents (69.2%, 9/13) and negatively affect recruitment. Several programs provided a prerecorded virtual tour (69.2%, 9/13) and still extended an offer of an in-person tour (53.8%, 7/13). More than one-half (53.8%, 7/13) anticipated that nonlocal students will be more difficult to recruit due to their lack of ability to visit the community.

Travel restrictions also limited “acting intern” rotations (AI), a handicap on intern selection noted by 30.8% (4/13) of respondents. Accordingly, 46.2% (6/13) of PDs planned less emphasis on rotation performance in their selection process.

Many medical students at times suffered rotation restrictions imposed by COVID-19 concerns, precluding many senior rotations in surgery. Despite the lack of clinical exposure during the senior year, only one-fourth of PDs (23.1%, 3/14) expressed concern that resident dropout rates would be affected. Half (46.2%, 6/13) adjusted the first-year curriculum to include additional clinical skills sessions to help incoming interns compensate for limits in their experience.

In view of the novelty of video interviews and the expected problems with using them, many PDs (61.5%, 8/13) expected that they would rely more heavily on the United States Medical Licensing Examination (USMLE) scores in their selection decisions. Anticipating the end of the pandemic, most plan to return to in-person interviews, with only one-fourth (23.1%, 3/13) expecting to continue with virtual interviews.

In a survey conducted by the National Resident Matching Program, PDs ranked interactions with faculty and residents during the interview and visit as the second and third most important factors in ranking, with the goal of evaluating the number one factor in the survey, the interpersonal skills of the applicant. ⁴ With the switch to video technology, it is imperative to reestablish the goal of the resident interview: to evaluate the candidate’s interpersonal skills: ability to communicate, establish a give-and-take interaction, and project an agreeable personality. All are possible in a virtual interview, but effort is required to overcome the lack of face-to-face human presence and the loss of body language. Overcoming these obstacles in virtual interviewing could create a more permanent presence for virtual platforms in future match cycles as the beneficial features of cost-effectiveness and time-friendliness are enticing attributes.

Prior to the interview day, faculty interviewers should be educated and trained on the virtual platforms they will be using and incorporate mock interview sessions. Test runs of the virtual platforms should be conducted, including reviewing how to manage breakout rooms and how to troubleshoot issues, and a reference packet should be provided for faculty that they can review and keep at hand.

Once invited to an interview, candidates should be sent a parallel digital information packet that outlines the process with contact information for further questions. The packet should also include links to a virtual tour of the hospital facilities and community information, including housing, daycare, schools, recreation, and local attractions.

To compensate for the limitations of the video interview other events should be part of the interview day, including a virtual “Happy Hour” where candidates mingle with residents. In less formal interactions residents and faculty can further interact with the candidates to ascertain their fit with the program.

For applicants, the virtual interviews are an economic boon, allowing them to apply to multiple programs without the costs of lodging and travel. ¹ The same limitations with virtual interviews apply to applicants as they do to the residencies, however. The key to making a good decision for professional training is to use technology to obtain relevant information about the training program and its people through the program website, PubMed, LinkedIn, Facebook, and Twitter.

The COVID-19 pandemic has force fed telecommunications into residency education and clinical practice. With careful attention to the overall aims of any interview for employment, the assessment of interpersonal skills and the fit of the individual to the organization, the virtual interview can be one of a number of tools to make the crucial decision of intern selection.