Web-based dermatology residency interviews in the time of coronavirus disease 2019 (COVID-19)

Dear Dr Dermatoethicist: I am a residency program director. Interviews are approaching to select residents and fellows. Because of social distancing measures enacted across the United States ¹ to mitigate the spread of COVID-19 and the inability to predict the course of this pandemic, social distancing may persist for months. ¹ What are the ethical implications of replacing the in-person interview with a web-based interview, as has been done by some surgical fellowships? ²

—Concerned Program Director

Dear Concerned Program Director: The decision to replace in-person interviews with web-based interviews has ethical pros and cons involving the principles of nonmaleficence, justice, and consequentialism.

Face-to-face interviews typically involve air, car, train, or bus travel, with extensive exposure to others. Public health authorities have advised social distancing to mitigate the spread of COVID-19.¹ Demanding in-person interviews would therefore potentially violate the principle of nonmaleficence, or doing no intentional harm, because the requisite travel may cause applicants to expose themselves and others to COVID-19. On a national level, having tens of thousands of applicants travel for interviews could have disastrous public health implications.

Justice suggests that the interview process be conducted in an equitable manner for all applicants. Criticisms of the current in-person interview process include its high financial cost expended on travel and hotels,³ which disproportionately disadvantages students of a low socioeconomic background. Pilot studies of web-based residency interviews have demonstrated that they decrease costs significantly for applicants.^{4 , 5} Moving toward a web-based interview system may thus inadvertently create a more fair interview process for all.

Consequentialism, or the evaluation of an action by its consequences, should be considered because there are a number of consequences that may result from the implementation of a web-based interview process, some positive and some negative. Previous studies have demonstrated that web-based interviews decrease costs significantly for applicants, decrease time burden by reducing time away from their home institution, and would help to mitigate scheduling conflicts that cause some applicants to forgo an interview for another scheduled on the same day or next day.^{4 , 5} On the other hand, drawbacks exist, including that web-based interviews limit informal interactions between applicants and residents that traditionally occur during the preinterview dinner and interview day.⁴ Web-based interviews also prevent applicants from assessing the “fit” of a program or area, which is highly important when choosing where to train. Additionally, applicants are unable to tour residency institutions' facilities in person and evaluate the surrounding housing opportunities.⁴

Given the public health dangers of COVID-19, conducting web-based interviews instead of in-person interviews is the ethical decision, especially if the pandemic persists. In Table I , we propose a web-based residency interview process to facilitate interviews in the time of COVID-19 while mitigating the aforementioned drawbacks of the online interview format. Web-based interviews should be conducted for all applicants, even those who want to or can attend in-person interviews, to promote a fair and just interview process. A well-implemented, web-based interview system has the potential to create a safer, more ethical and just interview process for all in this unprecedented time.

Table I.

Proposed web-based interview process.

Platform selection • Video interviews have been met with high levels of satisfaction in previous studies.4 , 5 We recommend the use of a free, accessible, online platform for video interviews that applicants are already familiar with. Options include Skype, WebEx, Zoom, and GoToMeeting. • To mitigate concerns about privacy, we recommend the use of a platform that can be secured. • We encourage a standardized online platform across residency programs to make the process easier for applicants and interviewers alike. Preinterview preparations • Interviewers and applicants should be encouraged to practice with the video-based platform so they feel comfortable during the interview. • Interviews should be conducted in a quiet, well-lit setting.2 We recommend using a reliable internet connection to avoid connectivity issues and using an ethernet cable or telephone hot spot as backup if connection problems occur.2 Interview format • Programs may choose to structure web-based interview days like face-to-face ones, with program overviews, interviews with faculty, and virtual facility tours. • We encourage video meetings between applicants and residents to give applicants the opportunity to ask questions in an informal setting. Residents should be encouraged to be honest about their residency experiences, thereby enabling applicants to better assess the fit of a program. Postinterview considerations • Applicants should be provided with resources and contacts within the residency program to address any questions they may have after interview day. • Given the fluid nature of the COVID-19 pandemic,1 applicants should be given the opportunity to conduct in-person visits at a later date if travel is deemed appropriate by public health authorities.