Primer to prepare medical students for virtual residency interviews

INTRODUCTION

Every year, thousands of medical students apply to residency via the Electronic Residency Application Service (ERAS). After submission, applications are reviewed and invitations are extended to candidates whose qualifications, interests, and journey align with a program's requirements and desires. Interview days are heavily weighted by both applicants and program leadership as each creates their respective rank lists. ¹ , ² In‐person interviews have historically provided an immersive experience with peers, faculty, hospital amenities, and city viewing. However, in‐person interviews have decreased in frequency since the COVID‐19 pandemic. ³ Virtual interviews, a cost‐, time‐, and infection‐sparing alternative, still allow an applicant to demonstrate their personal and professional strengths, clarify any concerns in their application, and inquire about the residency program and department. ⁴ They also allow the interviewer to assess whether an applicant meets the academic and clinical expectations of the residency program, adds to the cultural experience and well‐being of their peers, and demonstrates commitment to the field. ⁵ Despite the stakes of the interview for both parties, there are limited academic publications describing a strategic approach aimed at applicants who will virtually interview for residency. ⁶ Previous recommendations focused on in‐person interviews or content related to virtual interviews that are specific to residency programs. ⁷ , ⁸ , ⁹ Here we will provide applicant‐centered recommendations specific to the unique aspects of virtual residency interviews.

EQUIPMENT AND TECHNOLOGY SETUP

There are general housekeeping practices that will facilitate a smooth virtual interview experience.

Background

Applicants should have a simple and neat background. Decor need not be elaborate or expensive and it should not cause distraction to the applicant or the interviewer. The aesthetic of the virtual background should not be the most memorable aspect of the interview. Objects in the background may become the subject of conversation by the interviewer; therefore, it is important for the applicant to preview how their background appears before going on camera. One practical strategy is to utilize the medical school's official virtual background.

Internet, audio, and lighting

Reliable internet should be identified and secured ahead of the interview. If the applicant's home is not an option, a private, reserved room in the local library or on campus is an alternative. A cell phone, ideally with video call capabilities, should be available as backup. Interviews should always occur in a quiet, unoccupied room. Alerts and notifications can be distracting to both the interviewer and the interviewee and should be disabled or silenced. Care should be taken to remove any potential distractions (e.g., barking dogs, children crying, cats on the keyboard) to allow the interviewer to focus on your answers. The microphone and speakers should be tested to assure quality sound. Shadows, dim lighting, and high beams of light via a window or back lighting from any light source may limit the ability to view and connect with the applicant. Ambient light may be sufficient if it eliminates shadows or glare on the face. Supplemental lighting, such as a ring light, may be necessary for some rooms. Keep in mind that incorrect positioning of these lights can cause noticeable glare on eyeglasses, which can be distracting as well.

Camera setup

Lastly, the camera should be centered directly in front of the applicant's face and during active discussion eye contact should be directed towards the camera. Positioning the camera 1–2 feet away from the face meets general standards. Placing a post‐it note behind the camera with an arrow pointed to the lens can serve as a reminder to focus on the camera. The design practice “rule of thirds” states the focus of the frame, the applicant's eyes in this case, should be either one‐third or two‐thirds of the way across the image, both horizontally and vertically. ¹⁰ Shrinking the video size and moving it to the top of the screen may prevent the applicant from looking away from the camera.

Personal appearance

We want applicants to feel authentic and comfortable. Clothing, makeup, and hair \styles should appear purposeful and not in disarray. Business style clothing is a practical choice because it avoids distracting the interviewer from listening to the candidate's answers.

Backup devices

To help prepare for technological emergencies, it is wise to have a fully charged, backup device with relevant software loaded (e.g. Zoom) in the event one's primary desktop or laptop malfunctions. Ahead of the interview, have available any relevant interviewer phone numbers that were provided to use in the event of software failures or issues with internet connection.

ITEMIZED LIST OF PERSONAL QUALITIES AND EXPERIENCES

In preparing to answer questions, consider that the interviewer is most interested in evaluating the candidate's thought process as much as, if not more than, the final answer. Prior to responding, applicants should spend a few moments thinking about the question. Identify the “root” of the question; a question often probes into a specific aspect of an applicant (e.g., leadership experience, conflict resolution skills, research ambitions, overcoming obstacles). Applicants should center the response around the question stem and share a focused answer that is pointed and relevant. We highly recommend against delivering overly rehearsed and stock answers. A natural response is best delivered by speaking in a natural voice and allowing the answer to feel tailored to the nuances of the question. We discourage the use of a fixed, written script while answering any questions. We do recommend creating an itemized list of key strengths to emphasize in advance and then tailoring responses to include these. The item list can help provide a guide of the elements to emphasize in any answer (e.g., leadership, advocacy, community service). Students may post the list on the computer screen for brief reference. However, the list should not be extensive such that it appears the applicant is reading from a script. Similarly, identify anecdotes ahead of the interview to use for common questions (e.g., overcoming obstacles, addressing unethical cases, managing disagreements).

MOCK INTERVIEWS AND ADDITIONAL RESOURCES

Applicants may leverage mock interviews at their medical school, for instance, to prepare for official interviews with a residency program. There is significant data about the positive impact of mock interviews for medical students. ¹¹ , ¹² , ¹³ , ¹⁴ One study showed that students found feedback from mock interviews helpful and that students participating in mock interviews had a higher match rate than those that did not (94% vs. 90%, p < 0.001). ¹⁵ Many medical schools provide an opportunity to practice interviewing that is both cost‐effective and highly relevant. Candidates should treat mock interviews seriously, by wearing business attire, setting up the equipment and background, and answering questions similar to how they would in the actual interview. After the interview has completed, candidates should look for feedback on various aspects of the conversation, such as clarity and brevity of answers as well as if answers were relevant for residency interviews. Here, applicants can ask for feedback about their background, wardrobe, noise levels, and internet quality, if they have concerns. Students may also utilize additional resources to prepare for residency interviews such as podcasts, blogs, virtual communities (e.g., those found on X or Instagram), or books.

RESEARCHING THE INTERVIEWERS

Candidates may get a list of interviewers in advance. The lead time could be a few minutes to a few days ahead of the interview. Either way, candidates should take a moment to learn the interviewers’ areas of interest or even education and training background—as that information may serve as a topic of conversation or inquiry. For example, questions for an ultrasound director may focus more on ultrasound training for residents and fellowship opportunities, whereas questions for the research director may focus on resident research opportunities. Candidates may start by reading the interviewer's biography online, such as their education and training history and areas of professional interest, if available. Sometimes the interviewer may have a personal or professional website with further information such as prior lectures, awards, and research interests. While unrestricted professional social media accounts may be available, candidates should not request access to their personal or private social media accounts. Search engines, such as PubMed or GoogleScholar, can locate prior publications. ¹⁶ While an in‐depth review of all of their academic and research interests is not required, having a broad idea of their background, responsibilities, and interests will better shape questions and answers. If no information about the interviewers is provided in advance, remember to keep questions relevant for a residency interview. While “small talk” can warm up the room, avoid letting it take up the majority of the interview.

PREINTERVIEW SOCIALS

Many programs offer preinterview informational sessions or social events that help applicants get to know the residents. Given the limitations with travel, these largely remain virtual. Applicants should consider these events as extensions of the interview process and engage with others as if they are still being observed. While topics of conversation may be more informal (e.g., sports, travel, food), applicants should consider that anything stated may be considered as a component of their application. Negative commentary about other programs or rotations should not occur, as it is possible that it may be relayed to the corresponding program and generally reflects poorly on applicants. Therefore, be mindful of humor, offensive language, political or societal commentary, or expressing public judgment of others. While it may be tempting to “jump on the bandwagon” of critical commentaries made by residents in an attempt to fit in, this is discouraged. If events are in person and serve alcohol, applicants should limit their intake and be aware of their tolerance. While the participants, residents and faculty, of these sessions will appear friendly, an applicant should not consider them yet close friends.

ANSWERING QUESTIONS DURING AN INTERVIEW

Gathering initial thoughts

There is no strict time frame students should follow when it comes to answering questions. Generally, we advise taking a few seconds to gather thoughts for simple, expected questions and perhaps a few seconds longer for difficult or unexpected questions. This gives time to identify the key themes or anecdotes from the itemized list created during the preparation stage. We generally advise avoiding rushing into an answer before considering what information the interviewer is seeking and what the applicant wants to share. If there is confusion, it is strategic and reasonable to ask the interviewer to clarify a question by asking, “Do you mind clarifying the question?” Most answers should be less than 2 min in length, which means that you want to give high impact details in your answer to maintain the interviewer's attention.

Centering answers around a theme or anecdote

Each answer should speak to one central theme or anecdote to avoid rambling or complicated answers. You may choose to reference your itemized list prior to answering a question. For instance, the question “Tell me about an obstacle you have faced” seeks to see the journey traveled—what challenges one has faced and also how those challenges were overcome. Therefore, the answer should demonstrate a single personal obstacle as well as signs of growth and reflection. The question is not intended to elicit sensational or extremely personal details or to serve just as a source of entertainment for the interviewer. The purpose of the question is to show an applicant's degree of resilience, adaptability, problem‐solving skills, and ability to take lessons learned and apply them to future obstacles. Similarly, the answer should not appear mechanical or scripted. The interviewer wants to witness a candidate's natural ability to construct a career plan and devise a path to achieve it. Stock or overly polished phrasing or catch phrases that may sound like rehearsed speech. Applicants should also expect questions related to any concerns in their application (e.g., low test scores, absences, evaluation comments) and prepare cogent answers to explain them, coupled with examples of subsequent successes in the same areas.

Of note, the examples applicants use in answers do not need to come from a medical experience (e.g., volunteering at a hospital), but should directly tie in to how this experience has made you more prepared for residency. For example, if asked about your greatest accomplishment, you could discuss becoming editor for the school newspaper and then highlight relevant, extrapolatable elements, such as your work ethic, leadership, teamwork, delegation, or project management.

When structuring your answer, you can use a loose template to keep the answers focused (see Table 1). Start with a summary statement upfront. Then share a specific example and include pertinent moments of the story or data points that show the weight of the example. Add what you learned from the experience. When relevant, finish by sharing how this experience will help you become a better person or doctor. Please be mindful of having such rigid and stock answers that the interviewer feels you are too rehearsed and unnatural. It is okay to use a normal speech pattern and not sound perfectly composed as that really reveals your natural self to the interviewer. Your authentic voice will also allow you to be distinguished from others.

TABLE 1.

Example questions and responses using the framework.

Question	Summary statement	Specific example	Lessons learned	Residency relevance
“Tell me about yourself”	I'm someone who wants to provide access to others.	Before medical school, I worked as a math teacher at an underresourced high school.	I learned that these students needed much more than mathematical information and explanations, and I worked hard to teach holistically.	I hope to conduct research on how patient education leads to better health outcomes.
“Can you tell me what it means to be a leader?”	Leadership is defined as thinking in the best interest of the team.	In college, I was a health worker responsible for the well‐being of 40 freshmen in our dorm. There was a disagreement between the students and health workers …	I learned the power of listening before speaking. I made sure to listen to others before making a judgment.	This skill is important since as faculty we will be responsible for small and large teams and will need to be able to listen to all voices.
“Was there ever a time when you struggled academically?”	It was hard to balance studying for Step 1 and classes.	When studying for Step 1 I was taking a full load of classes. I found myself struggling with the mechanics of creating and following a schedule.	I learned the value of understanding my bandwidth and planning my time to be compassionate to myself.	Residency will require me to balance multiple obligations so I am grateful I learned strategies to balance my commitments and time.
“How important is community service for physicians?”	Community service allows for physicians to see the wider problems of society.	After college I volunteered at a shelter for undomiciled persons. There, I saw the various ways patients are left unsupported and unable to access medical care: such as getting medication, getting to doctor's appointments.	I learned a greater picture of the challenges our patients face outside of the hospital system and how hard it is for one to be healthy and access a health care system.	I hope, no matter my specialty, that I continue to value health equity and comprehensive medical care. This empathy will help me to understand the limitations my patients face when accessing care.
“I noticed your critical care clinical evaluation has a concerning comment about communication. Can you explain?”	At the start of that rotation, I was learning my role on the team and how best to work in a new, high‐acuity environment for the first time.	On one particular shift, a nurse had asked me to tell the doctor to cancel a medication order. I did not sense the urgency of this and waited until after didactics to relay the message. This caused the patient to get medication they did not need.	While there was no harm to the patient, I realized the weight of my judgment. This situation could have been avoided if I had asked the nurse about the urgency of relaying the message.	I've learned much more about communication and understanding timing and prioritization. This was a single episode that led me to be a better doctor and to prioritize interprofessional communications to optimize patient care.

ASKING THE INTERVIEWER RELEVANT AND HELPFUL QUESTIONS

While there is no such thing as a bad question, some questions are best answered by certain individuals. Additionally, targeted questions may provide helpful answers that lead to better understanding of the residency program. Applications should always consider the interviewer before asking a question: their expertise and perspective (see Table 2 to see how certain categories of interviewers might be best to answer certain questions). While virtual interviews have many advantages, much is lost not being able to see the hospital campus, the interactions between nurses and clinicians, and how traumas are run in person. Therefore, we encourage applicants to think about the aspects of a residency program that are best assessed in person and consider, at the very least, asking related questions during the interview.

TABLE 2.

Potential questions to ask programs broken out by role.

Title/responsibility	Topics they may best address
Program coordinator	“Can you speak to the administrative expectations of this residency?” “Can you share your perspective on the culture of the residency program?” “What sort of social programming occurs within the program?” “What are the typical reasons residents may come to you for support?”
Residents	“What are some of the nonclinical opportunities you have been able to participate in?” “What is the hardest part of your clinical schedule? Can you share how much input you have?” “How involved are faculty in your education and training?” “Can you speak to the quality of didactics? Are they given more by residents or faculty?” “Do you feel safe telling personal matters to your leadership team?” “Can you speak about the clinical environment? What do you like about the physical space? What can be improved?”
Nurses	“Can you speak to the nursing/resident relationships in the department?” “Can you describe the patient population?” “What do you think of the quality of care patients receive from the residents?” “What do you think of the culture of the residency?” “How does the department feel when boarding is high? Is there adequate capacity for a surge in patients?”
Core faculty	“Can you describe your history with the mentorship of residents?” “In what ways do you most often teach residents?” “What do you think of resident morale and energy on shift?” “How often are you given opportunities to teach during conferences?” “Do you find residents have the time to complete their projects with you?” “Do you think the residents feel in‐control of patients in traumas? How are they treated by other services, such as orthopedics and neurosurgery?”
Program director or assistant program directors	“Do you anticipate any upcoming structural changes in your leadership team?” “Would you be able to share the mission and values of the residency program?” “What are some ways residents thrive in this program?” “Can you share reasons residents may have left the department in recent years? How were they supported in this transition?”
Chairs	“What is the vision of the department and how it relates to the residency program?” “Can you share expectations of how often faculty should engage with residents?” “Is there accountability of faculty engagement?” “What are the future plans regarding preventing or managing residency burnout?” “Can you elaborate on the role of EM within the culture of the hospital overall?”

REPORTING UNCOMFORTABLE EXPERIENCES

Not all interviews go smoothly and sometimes there is an inclusion of forbidden questions: about plans for parenthood, number of programs interviewed, and information about applicants' top program, for instance. We also know that students underrepresented in medicine have distinct challenges with interviews. ¹⁶ If a situation occurs that is uncomfortable, applicants may consider waiting until the interview day has concluded to speak about the behavior. In general, it is best to avoid engaging in contentious dialogue and to keep the conversation neutral to positive. If an offensive comment has been made, applicants should remember it, write it down, and share later. In moments where a candidate truly feels immediately or severely unsafe, consider requesting for the interview to conclude—however, for many this could feel like an intimidating request. After the interview, candidates should speak with a trusted member of their medical school—an advisor or dean—about the incident. Discuss the timing of reporting: now versus after Match. Many students opt to hold on formal reporting to protect their chances of matching. Others report shortly after the incident to help protect the experiences of other students. Formal reporting should be made by the medical school leadership (e.g., advisors, members of the dean's office) to the program director personally versus reporting via NRMP. The responsibility of formally reporting a program or faculty member should not be placed on the individual applicant.

DOWNTIME DURING INTERVIEWS

Often there will be time and space during the interview day where applicants will be left waiting. During shorter breaks, less than 2–5 min, we recommend applicants remain at their laptops and available. For more extended windows, refreshments and bathroom breaks should be used as needed. Please be mindful to ensure all video and audio is off before speaking with others about the interview day.

AFTER THE INTERVIEW

It is optional to send a brief and personalized “thank you” message to the program team who were involved during interview day: program coordinators, interviewers, and residency leadership team. These gestures are fully optional and should not impact a candidate's chances of matching at a program. These messages can be either via email or handwritten. A message can include a short greeting and provide thanks about the interview and one notable topic that was discussed to help identify the applicant.

Candidates may also request to meet with faculty or residents who were not available on interview day. For these meetings a specific question should be asked, such as, “I'd love to discuss the potential opportunities residents may have to collaborate on research with you.” Use this request as an opportunity to further understand if the program feels supportive and if mentorship is readily accessible. However, keep in mind that faculty and residents are busy and their lack of availability to meet might not be representative of their availability for active residents. While these meetings are not a formal interview, they may factor in—positively or negatively—on the ranking depending on the interaction.

After each interview, candidates should reflect and learn from possible errors to best prepare for the next interview. They should write down the questions they were asked and reconsider the answers given. One strategy is to practice reanswering the questions that were considered challenging. Additionally, candidates may reflect on the questions asked of interviews and if answers were rich and detailed. If answers did not seem to stimulate conversation, consider rewording the questions to be more specific and open‐ended. Lastly, applicants should write down any nuances from the interview day that they want to keep in mind as they later create a rank list.

CONCLUSIONS

Interviewing for a residency position is an opportunity to assess mutual fit for the prospective resident and the program. To maximize the interaction, it is incumbent upon the interviewee to prepare thoroughly in advance of the interview by ensuring an appropriate appearance and technically functional workspace, researching the program's unique qualities; considering important points to convey during the interview, and making plans for following up with the program personnel.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Landry A, Coates W, Gottlieb M. Primer to prepare medical students for virtual residency interviews. AEM Educ Train. 2024;8:e11020. doi: 10.1002/aet2.11020