Programs and applicants displayed incredible adaptations during the 2020-2021 virtual residency interview season despite the adversity they faced due to COVID-19.

Moving forward, virtual features may be integrated with traditional methods for a more equitable and favorable experience. We present here a discussion on the pros and cons of the 2020-2021 “virtual” residency interview season — and ways of hybridizing virtual and in-person practices that reimagine modern interviewing and improve applicant equity.

The pros of virtual interviews

There are two salient benefits of virtual interviews. The first is the reduction of financial costs. In 2016, the majority of applicants spent at least $2,500 in interview costs, with 13% paying over $7,500. Students may require extra loans to pay for their travel and lodging.

This year, without in-person interviews, there are essentially no expenses beyond application costs — other than, perhaps, the purchase of interviewing equipment. But even if a student buys a ring light, a camera and a quality microphone (roughly $200 in total), the amount of savings cannot be ignored.

The travel and lodging expenses amassed during previous cycles may be considered unfair, unprofessional, and unnecessary in light of this year’s alterations. In-person interviews advantage applicants with greater financial aid resources or willingness to incur more debt. Since a clear method of reducing costs is readily available, we are ethically compelled to implement it.

Virtual interviews also take up less time than in-person interviews; offering minimized disruption of clinical duties. According to applicants, most clerkships do not offer adequate time off for interviews, despite the 4th year being designed to allow more flexibility. The in-person interview process can span several days when travel time is included, but virtual interviews do not require travel and thus minimize time away from the clinical environment. Additionally, conflicts due to overlapping interviews are common during in-person interviewing, forcing students to choose which ones to attend. Virtual interviews are less time-intensive and promote equity as applicants can decide which interviews to attend without time constraints influencing their opportunities.

The cons of virtual interviews

One of the downsides to interviewing virtually is the loss of face-to-face interaction, which includes a lack of social engagement with residents. There are fewer opportunities to chat in a relaxed setting or to observe personnel interacting with one another. Virtual sessions also limit the time to converse with fellow applicants, which can be a fun way to engage with future colleagues.

Another disadvantage of an all-virtual practice is that applicants are unable to experience the program’s city or facilities. Desired geographic location is one of the most frequently cited considerations amongst U.S. senior medical students when applying to and ranking programs. Around half of applicants relay that the quality of hospital facilities impacts their choices. A confident decision can be difficult without experiencing the location first-hand.

A hybridization of virtual and in-person methods

We believe that the majority of future interviewing should remain virtual. It is clear that traditional interviews present financial burdens and time constraints that diminish applicant equity. However, we understand that some applicants and programs will continue to prefer in-person interactions, so a compromise between in-person and virtual methods should be considered.

Optimizing elements of both in-person and virtual practices, we believe that each applicant should be offered the opportunity to visit the campus and experience the city in which the program resides. The optional nature of such a visit is imperative; in the past, students have felt pressure to participate in optional “second look” opportunities in order to remain competitive. Despite this emphasis on being optional, we must consider how visits could affect programs’ rank lists. If an applicant visits a program, but their peer does not, would the program regard the individuals differently? This would offer an edge to those who could financially or physically afford to travel. Several systems may be utilized to counteract this issue: Here, we present three of them.

Instituting a “visit cap” is one way of offering interviewees a chance to visit without disadvantage by limiting the number of programs to which an applicant can travel. This way, an applicant could visit a finite number of programs (say, their top-three programs of interest). Such a system places a cap on cost, minimizes the exhaustion and logistics of travel, and still provides sought-after information. But residency programs would need to recognize that a student could still be interested despite not visiting in person. Ultimately, such a system stands to benefit programs and applicants alike.

An alternate approach is a “blinded” visit in which the applicants interact with the GME office staff rather than the program leadership. Program leadership would not be informed of an applicant’s visitation status, preventing the visit’s use as a ranking metric. This low-stakes opportunity may allow the applicant a more informed decision without compromising rank. This option would require robust GME support and availability.

A final option is to move up the deadline for programs to certify their rank-order lists. For example, if programs finalized their rank order list by February 15th but applicants didn’t have to certify until March 1st, applicants could take the two-week window to complete in-person visits. Applicants could visit knowing that their presence or absence would not affect ranking. In order to ensure program compliance, such deadlines would require NRMP regulation.

Conclusion

COVID-19 propelled the 2020-2021 residency interview season into a virtual environment — one that required many adaptations. Evaluation of this unprecedented interview cycle highlights the need to revise traditional methods of interviewing. We appreciate the positives of virtual interviews (fewer costs and time constraints), but we understand that some people prefer in-person encounters. As such, offering a combination of approaches would be beneficial. The ability to visit programs in a non-biased, low-risk setting while conducting the remainder of the process remotely offers future physicians the combined benefits of both in-person and virtual interviewing.

Acknowledgment: Thank you to Dr. James Carmody for his guidance and input.

Nicholas M. Heitkamp is a pediatrics resident and co-founder, FuturePedsRes. He can be reached on Twitter @nmheitkamp. Lucas E. Morgan is a child neurology intern and can be reached on Twitter @lucasemorgan. 

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