Medical Residency Interviews: Time for a Change?

Coronavirus disease 2019 (COVID-19) has had profound effects on medical education within the United States. Some affected practices (eg, exclusion of senior medical students from clinical rotations) are likely to recover as rates of COVID-19 infection decline and hospitals return to normal procedures. Timing of recovery of other medical education practices is less clear. For example, the future of medical residency interviews remains uncertain. As of May 14, 2020, the American Association of Medical Colleges recommends that all interviews with potential students and trainees be conducted virtually.¹ This relates in part to uncertainty regarding the safety of air travel and large gatherings. Before determining the appropriate resumption of on-site interview practices, a more fundamental question must be considered first: Whether to return to on-site interviews at all.

On-site interviews have long been considered integral to the graduate medical education application process. Reported advantages of on-site interviews are numerous (Table 1).² On-site interviews facilitate assessment of candidates regarding noncognitive factors (eg, communication skills) and negative characteristics (ie, red flags) by programs. Applicants describe face-to-face interaction with program members, particularly residents and the program director, as very beneficial. Additionally, on-site interviews are shown to strongly influence rank list construction by both program directors and candidates.²

Table 1.

Advantages and Disadvantages of On-site Residency Interviews^2,4

Applicants	Advantages	Face-to-face interaction with program members (eg, residents, program director)
		Assessment of program and social fit
		Assessment of program intangibles (eg, morale, “red flags”)
		Correlates with rank list construction
	Disadvantages	Significant cost (financial and opportunity)
		Potential for inequitable experiences among applicants (eg, interviewer bias)
		Financial, scheduling, and cultural factors may influence outcome
		Reported benefits unsubstantiated by available literature
		Significant absence from medical school
Residency programs	Advantages	Face-to-face interaction with candidates
		Assessment of noncognitive factors and negative characteristics
		Correlates with rank list construction
	Disadvantages	Significant cost (financial and opportunity)
		Does not adequately predict residency training outcomes
		Reported benefits unsubstantiated by available literature

In contrast, opponents to traditional interviewing have leveled many criticisms (Table 1). First, on-site interviews result in substantial financial and opportunity costs to applicants and programs. During the 2014–2015 application cycle, the average cost to each applicant participating in on-site interviews was $3422.71.³ Next, low interrater reliability, interviewer bias, and absence of standardized approaches may result in dissimilar and inequitable experiences among applicants.² Across distinct disciplines, on-site interviews have been shown to handicap candidates who are financially disadvantaged, have scheduling conflicts, or are culturally dissimilar to interviewers.⁴ However, despite these shortfalls, a viable alternative to on-site interviews has remained elusive.

Before the onset of the current pandemic, authors recently began suggesting implementation of virtual interviews in an effort to mitigate drawbacks associated with on-site interviews.³ However, few formal studies of virtual interviews exist.^3,5 Theoretically, virtual interviews allow for an equitable application process while concurrently reducing costs and optimizing flexibility for candidates and programs. Although both virtual and traditional approaches have attendant strengths and weaknesses (Table 2),³ we believe that the disadvantages of on-site interviewing outweigh its benefits to a greater extent than for virtual interviewing.

Table 2.

Advantages and Disadvantages of Virtual Residency Interviews^3,5

Applicants	Advantages	Increased scheduling flexibility
		Reduced cost
		Significantly less time away from work
		Potentially reduced biases
	Disadvantages	Precludes face-to-face interaction and assessment of noncognitive factors
		Most applicants consider less effective than traditional
Residency programs	Advantages	Increased scheduling flexibility
		Reduced cost
	Disadvantages	Precludes face-to-face interaction and assessment of noncognitive factors
		Most program directors consider less effective than traditional

Moving forward, a comparative analysis of virtual and traditional approaches is necessary to optimize the interview process in a data-driven fashion. In the upcoming application season, it is likely that residency programs will hold virtual interviews due to lingering effects of COVID-19. Should this occur, medical schools, residency programs, and additional stakeholders will have an opportunity to formally and on a widescale basis examine the benefits, limitations, and utility of virtual compared with on-site interviewing, as well as overall impact on the application process. Such an opportunity must not be squandered. Indeed, we believe that virtual interviews are not simply an alternate to traditional interviews, but may prove superior.

DISCLOSURES

The authors have no financial interest to declare in relation to the content of this article.