Fostering Certainty in an Uncertain Era of Virtual Residency Interviews

The COVID-19 pandemic has caused major disruptions in medical education. Most medical schools abruptly converted teaching to virtual classrooms and halted or dramatically reduced in-person clinical experiences. In light of these changes hindering medical students from completing required rotations, the Coalition for Physician Accountability issued guidance in May for the 2020–2021 residency application cycle.¹ In addition to discouraging most away rotations and delaying release of applications through the Electronic Residency Application Service, the coalition recommended all residency programs perform virtual instead of on-site applicant interviews this cycle.

We commend these decisions to prioritize faculty, resident, and applicant safety during this pandemic, as well as to potentially increase equity among applicants across the socioeconomic spectrum by eliminating interview travel costs. However, virtual interviews create new obstacles; they limit applicants' opportunities to visit residency programs, interact with residents and faculty both formally and informally, experience programs' clinical and educational environments, observe didactics, understand residents' responsibilities and opportunities, assess programs' patient populations, and evaluate cities or towns firsthand. As the top factors influencing US medical student applicants' ranking of residency programs are overall goodness of fit (89%), interview day experience (82%), and the quality of residents (75%),² current applicants may have less information on which to base their residency choice—which arguably represents the most formative years of clinical training.

Here, the authors (a former residency program director and a medical student residency applicant) propose several strategies for residency programs to optimize applicants' understanding throughout the application, interview, and ranking process (Table). These 5 methods should help mitigate the aforementioned obstacles and cultivate enhanced fit between programs and applicants.

Table.

Strategies to Foster Dissemination of Residency Program Information to Applicants

Dimension	Methods to Share Dimension with Applicants
Program website	• Summary of residency program, including mission, program leadership, faculty, residents, hospitals and clinics in which residents rotate, residency track opportunities (eg, research track, leadership tracks, additional degrees), and number of residency spots each year12,15,16 • Message from the program director or chair in a video and/or written statement15 • Photographs and video clips of the residency program across the years, including photographs and clips from resident retreats, social occasions, and clinical teams4,17,18
Application process	• List of application components, including program-specific requirements (eg, secondary essays, USMLE Step 2 CK score) and deadlines for receipt18 • Up-to-date visa sponsorship policies for international medical graduates • Interview selection criteria13,18 • Contact email18 • Virtual town hall to answer applicants' questions and to discuss changes the program is making this application cycle
Setting	• Description of facilities • Video tour of the city/town or neighborhood2,17 • Video tour of the hospitals, clinics, and department12,18 • Video tour or photographs of resident-specific work rooms or lounges12 • Links to local community resources18
Patient population	• Demographic data of the patient population on the program website, including race and ethnicity, age groups, and socioeconomic information of patients15,18
Curriculum and didactics	• Description of didactics15 • Example resident year-long rotation schedules and call schedules12,15,18 • Description of year-to-year progression of resident responsibilities12,15,18 • Different subspecialty experiences and opportunities for clinical immersions, remote/away electives, and electives in different departments12,18,19 • List of electives and the amount of time residents have at the program to experience subspecialties in which they may want to pursue a fellowship15 • Recorded videos of resident didactics • Recorded videos of grand rounds and/or case conferences • Video interviews with residents discussing the curriculum and didactics, and resources that they use to prepare for board examinations14,17
Research	• Description of research requirements and support14 • Video interviews of different residents conducting different types of research (eg, basic, clinical, epidemiology, informatics)14,18 • Video interviews of faculty conducting different types of research (eg, basic, clinical, epidemiology, informatics)18 • Sources of research funding, if available • List of resident and faculty publications and conference presentations4,12,17,18
Resident life and culture	• Videos of “A Day in My Life” for residents, which follows a resident throughout their day beginning at home, transporting to/from work, and navigating a typical workday4,12,18 • Video tour of residents' homes and neighborhoods12,13,16,17,20 • Interactive Q&A session with residents, questions for session can be collected beforehand and the session recorded4,13,17,18,20 • Pre-interview, virtual coffee chat or happy hour with residents4
Extracurricular activities	• List of extracurricular opportunities open to residents • List of activities that current residents are engaged in, such as volunteering, outdoor activities, classes, and family time17 • Opportunities to teach medical students • Opportunities to serve in free clinics for underinsured or uninsured patients • List of different journal clubs and articles discussed in the them
Distinguishing factors	• Video interview of program director explaining the program's mission, which residents thrive in the program, and factors that set the program apart4,13,21 • Video interview of residents explaining how they chose the program and what factors they believe distinguish the program from others15 • Videos or quotes from residency program alumni that explain how well the residency program prepared them for their respective careers17,18,22 • Residency program benefits, health insurance, salary, parking, meal allowance, and vacation time12,13,15,18 • List of careers and fellowships pursued by residency graduates each year18,23 • Q&A forum on the program's website for interviewees to ask questions • Social media platforms to share photographs and events from the residency program throughout the year, as well as keep applicants updated on deadlines and policy changes as the application process evolves18,23

1. Create and maintain a comprehensive, informative residency program website. Undoubtedly, applicants will rely heavily on remote methods to learn about programs this year. Program websites should include information on their mission, faculty, residents, curriculum, residency track opportunities (eg, research tracks, leadership tracks, or additional degrees), and number of residency spots. Several studies have revealed that many residency program websites are inadequately comprehensive.^3–12 An investigation of otolaryngology residency program websites found that only 80% listed didactics, 74% listed current residents, 70% described facilities, 64% discussed clinical schedules, 40% provided call schedules, and 33% provided messages from program directors.³ Another study found 98% of anesthesiology applicants reported using program websites while applying, yet only 46% of content items they found useful were actually located on program websites.⁴ Similarly, neurological surgery, plastic surgery, vascular surgery, and radiology residency program websites contained only 35% to 61% of content items useful for applying to residency programs.^5–8 Despite the inadequate content of many program websites, the information and quality of these websites play important roles in applicants' program selection and ranking; 41% of emergency medicine applicants reported not applying to certain programs based on information from their websites and 34% of plastic surgery applicants stated that program website quality influenced their decisions to interview at a program.^13,14 Program websites that clearly and concisely summarize core program attributes will serve as invaluable applicant resources for distinguishing programs and judging each program's mission.

2. Summarize application requirements and program-specific details. Relevant information to provide includes selection criteria such as test score cutoffs and deadlines for board examinations, recommended research and volunteer experiences, and visa sponsorship for international medical graduates. Additionally, nearly 70% of applicants have cited selection criteria as useful when applying to residency programs, but only a minority of residency websites provided such information.^5,6,13 Virtual town halls and social media (eg, Twitter) can provide outlets for programs to answer applicants' questions and address program-specific application requirements implemented this year.²³ These efforts will enable applicants to determine if they meet programs' admission requirements and priorities, and in turn, focus their efforts and resources on programs that are the best fit.

3. Capitalize on using multimedia platforms. Applicants will likely find multimedia, including videos and photographs, particularly useful in exploring intangible aspects of residency programs (eg, culture and resident happiness). Anesthesiology applicants consistently rank multimedia as “very” or “most” helpful for determining residents' happiness, learning how “fun” the program is, and feeling good about their residency program choice.⁴ Videos and photographs can be published on program websites, posted on social media, or sent to interviewees. Using videos, program directors and faculty can discuss the program's unique mission (eg, focusing on research, serving urban and underserved populations, or training rural physicians), distinguishing factors, examples of resident research, key educational and clinical experiences, and patient demographics. Such information can help applicants discover programs that better fit their personal and professional goals. Resident videos can focus on why residents chose the program, what they enjoy, and what clinical responsibilities look like.¹⁷ Creative and personal videos—following residents through typical workdays, tours of the facilities, and tours of residents' homes and the city—will enable applicants to more holistically understand the program's residency experience both inside and outside work. Photographs of department events and clinical teams can similarly help applicants learn about the program's culture and training environment. Videos may be the highest yield when kept short (eg, a few minutes), direct, and personal.^24,25

4. Publish pre-recorded videos of didactic sessions, clinical case conferences, and departmental grand rounds. Some programs emphasize resident-led didactics, while others primarily rely on faculty-led didactics and invited speakers. Exposure to the educational environment will enable applicants to better understand the program's teaching methods,¹⁵ residents' teaching responsibilities, and changes to residents' educational experiences due to the COVID-19 pandemic. If residents teach medical students and other trainees, videos depicting such resident teaching may also be valuable. If technological support allows, programs can post videos of entire conferences or multiple shorter videos (eg, 6–9 minute blocks corresponding to optimal length of medical education videos for viewer education).^24–28

5. Organize informal virtual pre-interview get-togethers and create Q&A forums for interviewees. Traditionally, pre-interview dinners and interview day “small talk” between applicants and residents gave applicants crucial transparency into resident and program culture and into perceived program strengths and weaknesses. This year, programs can offer informal coffee chats or happy hours with their current residents, whereby interviewees meet residents (eg, 2–3 interviewees per resident) virtually to learn about programs, hear candid reflections on training, and ask questions prior to interviews. These experiences will enable applicants to determine “fit” (ie, how well their personal, educational, and career goals and interests align with those of current residents and the program's philosophy). Following interviews, Q&A forums on residency program websites can provide space for interviewees to post questions. Implementing these strategies may require institutional technological support, but tech-savvy residents or faculty may be able to take on leadership or supervisory roles.

As programs pilot multiple initiatives for applicant recruitment and interviews, this application cycle creates several research opportunities, such as examining which mechanisms help applicants best determine program fit remotely. As web-based interviewing may potentially save applicants thousands of dollars by eliminating travel costs,^29–34 broad-scale studies can examine whether virtual interviews benefit applicants across demographic and socioeconomic lines. Studies on how often applicants match into one of their top-choice programs compared to prior years are also warranted. Finally, educators can investigate best practices for virtual content sharing, recruitment event timing (particularly considering international applicants), and needs assessments among applicants with resource limitations (eg, broadband connectivity for applicants in rural regions or internationally).

Just as medical educators rapidly adapted to the COVID-19 pandemic by building virtual didactics and telehealth experiences, we anticipate residency programs will successfully adapt their online content and recruitment efforts to better inform applicants. We live in an era of uncertainty that is constantly evolving—let us evolve residency program recruitment by facilitating communication and engagement with applicants along the way.