As coronavirus disease 2019 (COVID-19) restrictions begin to lift, an inevitable question is whether or not we should return to in-person interviews for fellowship.
The advantages of the virtual format are clear. The format essentially eliminates the direct and indirect costs associated with in-person interviews. This includes travel, transportation, lodging, and food, as well as indirect costs such as hiring additional help back at home. It also improves convenience—to the applicant, their support system, the program, and their co-residents. This meant less time for my wife to handle 2 kids on her own—a challenge that cannot be understated. It meant fewer missed calls. Fewer missed cases. Overall, it was easier for everyone. But there are downsides as well.
To start, the virtual format reduces the ability for applicants to get to know one another. Many faculty and fellows I have spoken with reflected fondly about the interview tail and continue to keep in touch with what is an accomplished group of likeminded individuals who have now become their colleagues and collaborators.
Second, the format assumes that all individuals have access to an appropriate interview environment at all times of the day. For some, they could roll out of bed, put on dress clothes, and a few minutes later could be interviewing across the country. But this is not the situation for all. I, for one, live in a modest 2-bedroom apartment. My oldest occupies one room. My wife and I are in the second. And our youngest currently sleeps in our combo office/living room/kitchen. This did not make for a suitable interview environment, especially when East Coast programs often started interviews at 7:00 am Eastern time, long before my kids were awake. I was fortunate to be able to use a call room in the basement of our hospital. I’m sure many had it worse than I.
Third, there was limited ability for applicants to get a feel for the people, the program, and the city. Programs varied in their presentations from one 20-minute prerecorded slide show to 5 hours of live talks. There was no standardization of what was presented. Some programs offered town halls or socials for applicants to ask additional questions, but I was frequently left wondering about relatively basic things at the end of an interview day like availability of office space and the call schedule. And even the best presentation did not mimic walking around the city or seeing the subtle body language or comments that provide enormous insight into the culture of a program.
Fourth, and perhaps most importantly, the virtual format fundamentally changed the way I approached the interview trail. When interviewing for residency, I remember having a lot of time to immerse myself in the process and to reflect on my clinical and academic ambitions. There was unused time where I was able to ponder fundamental questions: What did I want out of a residency? How did the people and place feel? Instead, with the virtual format, interviews were squeezed between clinical responsibilities. I would check charts, call the intern for updates, and assign case coverage in the gaps in the interview schedule. Interviews were often on back-to-back days with short gaps between one interview ending and the next “social” beginning. Interviews were no longer an opportunity to learn about a program and for engaging in introspection, but simply another check box for the day. As I approach the end of the trail, I am less certain that the benefits of the virtual format outweigh the costs. What is the value of protected time to focus on your career?
Some have suggested a hybrid format—offering virtual interviews and then selective in-person visits. I would argue that this introduces a slippery slope that would quickly become a race-to-the-bottom. Applicants are inherently neurotic, and we have little insight into how competitive we are. I think most would feel compelled to visit every place they rank to demonstrate interest.
I, for one, would argue for keeping the in-person format. Many disagree. If we do keep the virtual format, I would advocate for a few ground rules:
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In-person “second looks”, especially if they occur before programs certify their rank list, should be discouraged. If an applicant chooses to visit an institution or city on their own accord that is, of course, permissible, but no tours or meetings with program leadership should be held.
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Programs should be cognizant of time zones.
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Programs should prepare presentations that cover the basics of the program and make these available to applicants ahead of time. This would allow applicants to focus their questions on less tangible aspects such as fit and feel.
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Consider coordinating interview days so that there is at least 1 or 2 days between interviews. This will provide time for applicants to reflect on their experience.
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Overseeing organizations—such as Society of Surgical Oncology or American Association of Endocrine Surgeons—could host socials before the interview cycle to allow applicants to meet one another. Society meetings may be an opportunity to facilitate this virtually or in-person.
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Residency programs should provide resources to help protect applicants during the interview season—to allow them to have time to appropriately prepare and reflect on their experiences and to provide space for those who do not have access at home. One potentially radical suggestion is to have the Accreditation Council for Graduate Medical Education consider interview time as a part of work hours.
The merits of a virtual interview format are clear. But there are real downsides as well. If the virtual format is maintained, steps should be taken to ensure applicants and programs are making educated and thoughtful decisions.
Funding/Support
No funding was provided for this article.
Conflict of Interest/Disclosure
The author declares there are no conflicts of interest.