Factors beyond cost and equity have gone into the decision to remain virtual at many institutions, including the environmental impact of travel, pulling medical students away from educational activities and rotations during that travel time, and the convenience of students being able to schedule more than one interview each day.
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April 2024Dr. Diaz said that the argument a lot of otolaryngology program directors make for in-person interviews, however, is that because it is a more competitive specialty, otolaryngology applicants will probably travel to fewer programs and may be more willing to make compromises and sacrifices to travel to those programs to compete.
“In a more selective arena like otolaryngology, you would want to be more selective with where you want to go,” he said. “There’s a cost advantage to doing these interviews virtually, but there’s obviously a huge detriment to not meeting your potential professors in person or seeing the institutions when the applicant pool is so restrictive already.”
Steven Pletcher, MD, residency program director of otolaryngology at the University of California, San Francisco, said deciding whether to go back to in-person interviews or not would have been a difficult choice to make if that choice hadn’t been taken out of his department’s hands. And yet, he added, it’s a bit different from specialty to specialty, acknowledging that otolaryngology programs last for five years, with only one to five residents per year, whereas other specialties, like internal medicine, often have more than 100 residents and last only three years; the stakes may be higher for otolaryngology residents in terms of finding the right fit. “I’m not sure that a one-size-fits-all approach is the right way to go,” he said.
John Carter, MD, a clinical professor of otolaryngology at Tulane University and system chair of otolaryngology at Ochsner in New Orleans, said his program is also staying virtual for now, but he anticipates returning to a hybrid model in the future to allow for the benefits applicants enjoy by getting to visit New Orleans during interviews, while also offering a virtual option for candidates who don’t have the financial means to travel. “We interviewed somebody from the Dominican Republic who didn’t have the means to travel and said if we didn’t have a virtual option, he likely would never have been able to come interview,” he said.
Faculty turnout for virtual interviews at Ochsner has been better than for in-person interviews, according to Dr. Carter, because faculty are located at multiple sites around the city, and it’s easier to participate in an interview from a desk at their site than it is to be there in person. They’re also able to interview more candidates in less time and finish by 1 p.m., which means they can begin their afternoon clinics on time. Yet despite the convenience all around, when Dr. Carter asked candidates at the end of their interviews if they would have preferred to interview in person, the majority said yes. And Dr. Carter understands why.
“A lot of candidates have never been here,” he said, “and I think that New Orleans is one of those cities where it really helps to experience it, to get a feel for the food, music, and culture.” He added that there are things about New Orleans, such as its reputation for crime, that work against it, but when candidates see the city in person and experience the positive aspects, it helps. “It also helps for them to have the full picture, so they know what they’re committing to for five years of their lives,” Dr. Carter said.
A few programs last year allowed interviewees to attend a second look day to visit after the programs had submitted their rank list. “It’s something medical students are eager to do, Dr. Pletcher said, “but I think it can become complicated and messy.” Some students asked during the pandemic, and the answer was an easy “no” for Dr. Pletcher. Now, however, he said it felt awkward when someone said they were coming to visit an uncle in San Francisco and wanted to stop by and see the hospital.
There are rules that are supposed to be followed by all graduate programs for visiting and second looks, determined by the council of Designated Institutional Officials (DIOs), said Dr. Diaz. They require that the applicant come see the school only after the program has locked and submitted their rank list so that the visit doesn’t affect the list in any way. Dr. Diaz said there were a few applicants who asked if they could visit for a second look, but their rank list had to be done very close to the deadline because of how faculty scheduling works at UC Davis, so they didn’t make it an option this year. “It didn’t seem equitable to say, ‘You can come between these five days,’” he said.
Match Rates Stay Consistent
None of the faculty we interviewed said that there have been any surprises with residents interviewed virtually, and all said that Match rates have remained consistent in the years of virtual interviews.
“Our program’s Match rates in terms of how high or low on our rank list we had to go hasn’t seemed to change much at all,” Dr. Diaz said. “And speaking anecdotally with colleagues and other program directors who are friends, it doesn’t seem to have changed so much. I think we’ve all been fortunate.”
Dr. Carter agreed, noting that despite conducting all virtual interviews, his program hasn’t seen any change in how far down their rank list they had to go to fill their residency slots. And there really have not been unpleasant surprises in the residents these programs got through in-person interviews versus the ones they admitted since virtual interviews began.
“That first year we wondered,” said Dr. Diaz. “But all of the years we’ve been doing virtual interviews, our cohort of residents have remained outstanding. Students who go into otolaryngology are excellent, and we’ve been very fortunate. I think it’s going to be uncommon to have a blip on that radar, whether it’s virtual or in person. It’s helpful for programs to see candidates in person, but I think it’s probably more helpful for the applicants to see the institution.”
Still, in-person interviews are hard to beat, according to Dr. Diaz. More reserved candidates were sometimes more challenging to get to know in a virtual setting, and trying to tease out some of the more interesting parts of their personalities or learning more about who they are as people were difficult. “It can just be harder for some people to connect in a virtual setting,” Dr Diaz said.
Dr. Bock agreed, noting that one of his medical student mentees last year was an excellent candidate academically, but struggled in Zoom interviews and didn’t match. Despite having done a couple of practice Zoom interviews with him, Dr. Bock found himself wondering if his mentee didn’t match because of the specific way in which the Match works. “In order to match, I think some programs have to put you higher on their lists,” Dr. Bock said. “If you’re in the middle or bottom of everybody’s lists, you may get ranked by multiple programs, but all of the slots are gone by the time they get to you.”
A new signaling process this year did help level the playing field for quieter candidates, according to Dr. Bock. This year, to avoid having candidates apply to an overwhelming number of programs just to secure interview offers, otolaryngology programs went to a high-signal model in which each candidate could send 25 signals to their top choice programs. Programs then prioritized those candidates for interviews.
In the end, Dr. Bock said, in-person interviews just seem to work better for everyone. “Virtual interviews can be mentally exhausting,” he said. “I think you get a certain energy back just from talking to somebody who’s actually in your office. You get a better feel for their body language and the tone of their voice. In the end, I don’t think there’s any way a digital interview can beat that human interaction.”
A virtual setting, Dr. Pletcher said, can also make it a bit more challenging to recruit applicants the department is particularly interested in having as residents. This year, his department sent penlights to all of the applicants they interviewed. “But that’s just a little token,” he said. “It doesn’t create an interpersonal connection.”
Now that the 2023 Match is complete, the jury is still out on whether residency programs will continue with virtual interviews, offer a hybrid option, or return permanently to in-person interviews. Opinions abound, but it’s clear that equity and access will continue to drive the conversation as the medical education community seeks to balance the benefits of face-to-face interaction with the reality of limited time and resources.