Three years after the coronavirus pandemic made residency interviews virtual, some programs have begun to do in-person interviews again this year, to the delight of some resident candidates and faculty.
“After going in-person this year, the overall impression was that it was an incredibly good idea for us,” said Jonathan Bock, MD, medical student clerkship director at the Medical College of Wisconsin in Milwaukee. “We have always felt that our program shows off well in person, and that was certainly confirmed again during this season’s in-person interviews.”
Even though COVID-19 is no longer the threat it once was, other programs are still conducting their resident interviews virtually and may continue to do so for the foreseeable future. There are several reasons for this, but primary among them is equity. Virtual interviews expand access to medical students who can’t afford to travel for in-person interviews. And the Association of American Medical Colleges (AAMC) concurred, adding its recent recommendation that residency and fellowship programs continue to use a virtual interview format to reduce the cost of interviewing to widen access and improve equity (https://www.aamc.org/about-us/mission-areas/medical-education/interviews-gme-where-do-we-go-here#recommendation1). This year, the AAMC reported that in-person interviews cost medical students between $400 and $7,000 per visit (https://students-residents.aamc.org/financial-aid-resources/cost-interviewing-residency).
When you’re able to be on site, you can access a better understanding of the personality and the culture of that institution; it wouldn’t be the same through a digital screen. — Jonathan Bock, MD
Despite the costs, however, Dr. Bock said that in-person interviews offer intangible benefits that can’t be replicated by Zoom. “Applicants get a much different insight into the program’s overall experience in person,” he said. “When you’re able to be on site, you can access a better understanding of the personality and the culture of that institution; it wouldn’t be the same through a digital screen.”
Rod Diaz, MD, residency program director of otolaryngology at the University of California, Davis, agreed that virtual interviews can’t compare to in-person ones for applicants. “In an in-person setting, there’s an ability to see the kind of meaningful interactions between residents, faculty, and the staff they’re working with,” he said. “I think you get a much better picture of the true culture of an institution or a department. It’s very difficult to accurately replicate that in a virtual setting.”
Points of Contention
Like Dr. Bock, Dr. Diaz said his program’s faculty favor in-person interviews, but the University of California’s five graduate training programs have mandated that within their five health systems resident interviews are to remain virtual. “It’s a bit of a point of contention,” Dr. Diaz said.
That first year we wondered. But all of the years we’ve been doing virtual interviews, our cohort of residents have remained outstanding. — Rod Diaz, MD
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.
Dr. 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.
Mitchell Arnold, MPH, a 2024 MD candidate at the Medical College of Wisconsin in Milwaukee, did both in-person and virtual interviews for residency this year. This was his experience.
MD Candidate Mitchell Arnold, MPH. Credit: Courtesy Mitchell Arnold, MPH
“I enjoyed in-person interviews because, generally, conversation flows better. I felt more like myself and that the interviewers had a better sense of who I was than the virtual interviewers did. Some other advantages of in-person interviewing were being able to meet faculty and residents directly, touring the facilities and the neighborhoods and cities where we would potentially live, and meeting other applicants. I made a lot of new connections while I was on the interview trail.
“There were some disadvantages, however, like the cost of travel and hotels, having to use more vacation days on my rotations, and having conflicting interview and travel dates. Virtual interviews, despite having their own flaws, were a nice break for me. I didn’t have to think about the logistics of travel, and I was able to do the interview on the road or at home.
“About 75% of my interviews were in person. Almost all in-person interviews were full days, with a half day of interviewing and a half day of touring the facilities and the city. There were also one or two socials for each interview, which made it fun to get to know faculty, residents, and other applicants in a more casual setting.
“By contrast, virtual interviews were much shorter, just a half day each. To make up for that lost social aspect, they all had virtual socials with the residents. Although fun, it was often hard to make any connections over Zoom, but it did serve as a good opportunity to ask questions about the programs. The virtual interviews themselves were similar to the in-person interviews, but I felt they offered less opportunity to show your personality; the silences were more apparent, we’d sometimes talk over one another, and our discussions would often get cut off when the admin would switch our rooms.
“Overall, I preferred my in-person interviews because they were more memorable and offered more opportunities to get to know one another. But it was also nice to have virtual interviews to reduce costs, travel, and make subsequent interviews that I would have otherwise had to miss due to travel.
“Many of my classmates expressed the same view. In general, in person was better but the option of having a virtual interview, if needed, would be nice. The interviews that were most memorable to me were the ones where I was able to share my passion and personality, which is always easier when you’re engaged in a discussion rather than a strict Q&A with standardized questions and memorized answers.
Renée Bacher is a freelance medical writer based in Louisiana.