Virtual versus In-Person: What Applicants Really Want in the Interview Process

The coronavirus disease (COVID-19) pandemic started in earnest in the spring of 2020, leading to numerous changes throughout society. Travel bans were instituted widely, which led to rapid conversion of in-person activities to virtual. This necessitated an immediate new approach to recruitment for the 2020 recruitment cycle (2021 MATCH), forgoing in-person interviews and instituting virtual interviews for all programs, according to numerous recommendations (1). Virtual interviews provide a substantial cost, time, and climate impact reduction (2). Removal of cost barriers has increased the number of applicants to programs (3) and has led to more applicants interviewing at programs where they otherwise would not have an opportunity to do so. Although there are considerable benefits to virtual interviews, and candidates find them favorable, the question remains whether virtual interviews should remain the exclusive option (4).

In this issue of ATS Scholar, Covert and colleagues present an article to evaluate the factors that influence the choice of interview format for pulmonary and critical care medicine (PCCM) and critical care medicine (CCM) fellowship candidates (5). Covert and colleagues used linked pre and postinterview surveys for applicants to the PCCM and CCM programs at their institution during the 2022 recruitment cycle (2023 MATCH) to evaluate the factors that influenced applicants’ choice of interview format. They used numbers and percentages for categorical statistics for preferred versus actual interview format and reported Likert scale responses using mean values and frequency distributions for the specific factors influencing interview preference.

Of the respondents to the preinterview survey who indicated a preferred interview format, the majority (57%) chose in-person interview (IPI) as their preferred format. They cited the degree of interest in the program, ability to assess program culture or fit, and ability to interact with staff and trainees as most important. For those who chose virtual interview (VI) as their preferred format, they cited the ability to arrange time away from work, cost, and distance of travel as most important. When evaluating which interview format candidates completed, 43% interviewed in person and almost unanimously would choose IPI again. For those who completed a virtual interview, the overwhelming majority would choose VI again, with a few choosing to add an in-person component (VI+).

This study was conducted at a single institution with excellent survey response rates. However, because of the small sample size of participants of VI+, their data were not included. There was no description of the in-person visit, so details regarding interaction with the program director, faculty, and/or fellows is not known. This limits the ability to understand what impact the in-person visit had on VI+ candidates’ evaluation of program culture and fit or other components they assessed during their in-person visit. In addition, the postinterview surveys differed based on the interview format. In particular, those who participated in VI were not asked whether they used other adjuncts as a proxy for being in person to evaluate program culture and fit. We therefore cannot evaluate what actions VI candidates took to determine their confidence in assessing program culture and fit. Last, only VI+ candidates were asked in their postinterview survey to explain why they would potentially choose a different interview format. Candidates completing IPI or VI responded that they would opt again for the format they completed, suggesting an overall satisfaction with their chosen format regardless of their preferred format. The reasons for this remain unclear.

What is notable is that few other programs were conducting in-person interviews or visits during the time of this study and that one-third of IPI candidates were local. This made travel much easier than in a recruitment season exclusively done in person. With the median cost of residency interviews being $3,000 (2), resuming in-person interviews would exacerbate the factors of inequity the authors mention. Simply stated, those who are given an opportunity to travel and can afford it, will.

In addition, what advantage is conferred to a candidate who interviews or visits in person over interviewing virtually? Although there has been some information on VI impacting a candidate’s ranking of a program (6), there is a paucity of data around the impact on the program’s ranking of a candidate based on in-person visits. A previous study has demonstrated that there was no difference in applicants matching within the same region or same institution as their core residency program after the institution of VI (3).

This study highlights the complex choices applicants face when selecting in-person or virtual fellowship interviews. Although most applicants initially preferred IPI, the demands of work, family, and finances led many to opt for virtual formats, with some candidates ultimately switching to VI because of life constraints. This shift prompts a critical question: if most programs offer in-person interviews or visits, are we creating a two-tiered system, in which some candidates have greater access than others? This is not in alignment with the equity we all strive for in recruitment.

Prior studies have evaluated the perspective of applicants with virtual interviews and have shown that virtual interviews can provide enough information to assess clinical experience, research opportunities, and program culture (7) but can impact what training settings candidates choose (8). In PCCM specifically, respondents believed that virtual interviews hindered their ability to evaluate program culture and their fit within the program and had the additional concern that interview format choice would impact how they were ranked by a program (9). If given the choice of in-person interview, they perceived IPI as the best option for improving their chances of being ranked highly by their program of interest. Conversely, when given the choice, they were more likely to choose or switch to a virtual interview for a program they had less interest in. Indeed, this was seen in the study by Covert and colleagues (5).

Virtual interviews remove significant barriers, such as travel costs and scheduling demands, making the interview process more equitable. However, Covert and colleagues demonstrate that many applicants felt less confident evaluating programs virtually, and this insight presents an opportunity for improvement. Should we focus on the interview format? Or is the real question whether we provide a virtual interview experience that clearly showcases our culture and values as a program?

Applicants in this study who preferred IPI listed the ability to assess program culture and “fit” and fellowship happiness as important factors for IPI preference. It is challenging not to conflate interview format preference with efficacy. It is possible to demonstrate efficacy through a virtual format, but it requires a new approach. Articulating and demonstrating essential dimensions of program culture to all candidates through means such as informative program websites, social media, and informal discussions with current trainees is important. Candidates should also have ample opportunity to ask questions of interviewers and of current trainees to gain perspective on the learning and work environment.

Although there is a perception that VIs are less effective than IPIs, it is very difficult to ascertain how the effectiveness is measured and what influences this perception. In addition, most current trainees have interviewed almost exclusively in the virtual format, making it difficult to assess effectiveness compared with a format they have not experienced. Future research should focus on specificity around what makes for an effective interview regardless of format and concrete assessments from candidates and interviewers on whether those measures were met.

A transparent, immersive virtual platform would allow candidates to make informed decisions without being limited by logistical or financial constraints, fostering a fair and inclusive recruitment process that respects each applicant’s unique situation. The goal should be a recruitment process that is trainee-centric and supports applicants’ diverse needs and life situations, while allowing all candidates to feel empowered and confident in their selection process.