Steven Tsoraides MD/ June 26, 2021/ Doctors, Medical Students

Now that the dust is settling on the pandemic in America, many residency programs are asking themselves how they will conduct interviews moving forward. Traditional thought left us assuming that it would be impossible to select a qualified candidate for physician training without ever meeting them in person. The success of virtual platforms for seeing and speaking with someone really challenge traditional thought.

In considering this dilemma, the benefits and disadvantages for applicants and programs need to be considered. It’s clear that the stress and expenses of the interview season have become too significant and were due for fixing anyhow. Virtual interviews allow an applicant to save thousands of dollars at a point in time where they have no money to spend and have accumulated significant debt already. With virtual interviews students are able to schedule a greater number of interviews and also potentially miss less time from medical education as they are able to squeeze out a few hours of a day instead of missing several days on end. I would imagine many students were thrilled by their ability to save time and money and increase their odds of matching given the number of interviews they were able to accommodate with this new model. The fact that most students apply to way too many programs and far more than they need to match is a whole other subject.

On the other hand, while we thought virtual interviews would be more of a disadvantage for programs, students may actually have the bigger disadvantage as they are unable to meet the people that they will be training with and see the environment in which they will be trained. Programs already know their environment well. Applicants typically have to accommodate to the environment of the program and not vice versa. Therefore, the gamble for students is actually greater than that for programs. Most applicants are highly qualified and metrics and applications allow programs to more or less target the candidates they are looking for anyhow. Students are left to decide with limited information they might be able to get from a website or word-of-mouth. Students may or may not be aware of the differences in the reality versus perceptions of the programs reputation. While programs were likely more fearful of virtual interviews, it may turn out the programs are the ones advocating more and more for virtual interviews while applicants are torn on what to do.

Let’s look at it another way as well. Now that USMLE Step 1 will move to pass fail, it will be harder and harder for students to stand out in a long list of applicants. Take away now that in person interview and there are less chances for an applicant to highlight their qualities and abilities. Social skills alone are significant factor in being a successful physician. Emotional intelligence may be harder and harder to elicit when we are sticking to scripted questions in a virtual format. Although conversations can occur virtually, typically it’s harder to initiate a more genuine interaction in this less than genuine setting. We don’t even know if our applicants are wearing pants.

Many programs are talking about a hybrid approach. This may include an initial virtual interview with an optional on-site visit. This too will create a dilemma for applicants. They will assume there will be a bias towards those who make the effort to actually visit a program, and this is likely an accurate assumption. Certainly many programs will try to avoid or overcome these biases. Many middle of the road candidates will likely end up where they would’ve ended up anyhow on a list. But it will be harder for those who want to stand out to do so unless they make the effort to make a visit. Then students will have to sort out another layer of scheduling and how to plan the second visit. This may actually result in more total time spent for the interview season and will certainly drive costs back up, thus negating the benefit in the first place. A hybrid approach actually may be the worst of both worlds rather than the best of both worlds.

There is a high likelihood virtual interviews are here to stay. It is certainly a convenience for many applicants and for many programs. This year in particular may pose even more challenges than the year prior when virtual was the only option without a doubt. Now that we have choices we may find ourselves more torn in crafting a system that benefits applicants and programs and is sustainable for the future. We must indeed stop the escalating cost of the application process and stop harming the future of our profession with increasing burdens of debt. Numbers of applications need to be limited or tiered to prevent applicants from putting themselves at harm while still ensuring a high likelihood that they can accomplish their goals and become successful.

The old model may find its way back into predominance. As a program director, I fear turning off applicants if I don’t give them the options they might prefer. I may force myself into a hybrid situation which in turn may create more problems for the applicant. Leading organizations are struggling to enforce a particular model as the needs of any individual program will vary across the nation. I do not anticipate we will have a solution that serves everyone well this year. I anticipate we will have a trial and error of many models over the course of the next several years to be able to hammer out a better future. The pandemic created a challenge and the solutions we identify will likely leave us in a better place. That said, I would be more than happy to enjoy a handshake, cocktail, and genuine conversation in person if the future gives us an opportunity. I think all program directors would agree that one of the highlights of the job is being able to meet so many energetic and talented people and experience the hope they bring to fields that we enjoy and are passionate about.

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