Mazzocca reports receiving research support from and doing consulting for Arthrex. LaPorte, Mulcahey, Purtill and Scolaro report no relevant financial disclosures.
For the 2020 to 2021 academic year, the Coalition for Physician Accountability released recommendations for residency and fellowship programs to commit to online interviews and virtual visits for all applicants due to the COVID-19 pandemic.
The Coalition for Physician Accountability extended this recommendation to cover the 2021 to 2022 recruitment cycle and the Association of American Medical Colleges (AAMC) recommended virtual interviews for the 2022 to 2023 recruitment cycle, citing high-level data that suggest the process of virtual interviews has been generally successful.
“At the onset of the pandemic, it was uncertain how [the pandemic] would impact us, in general, in our clinical practices and then residency and fellowship training. In response to widespread restrictions, we had to adapt to a virtual interview format fairly quickly,” Mary K. Mulcahey, MD, FAAOS, FAOA, associate professor and assistant program director in the department of orthopedic surgery at Tulane University School of Medicine, told Healio/Orthopedics Today.
In navigating the virtual interview process for residency and fellowship application, sources who spoke with Healio/Orthopedics Today said programs have aimed to keep the process similar to in-person interviews, including an introduction from the department chair and program director, as well as opportunities to speak with current residents, fellows and faculty about the program and the campus.
“We try to have [applicants] spend time with the current residents or fellows just by themselves so they can ask some questions without feeling like they are being judged by the people who are going to judge them,” Augustus D. Mazzocca, MD, MS, FAAOS, FAOA, medical director at Mass General Brigham Sports Medicine and chief of the division of sports medicine at Massachusetts General Hospital, said. “That is our attempt to give them a sense of the feel of our program.”
Providing a feel for the culture
Dawn LaPorte, MD, professor and residency program director at Johns Hopkins University School of Medicine, noted medical education programs have also added a virtual open house or social events that allow applicants the chance to get a better feel for the culture of the program.
“We have added an open house the week before, so it is outside the stress of the actual interview for the applicants to meet the residents,” LaPorte, an orthopedic hand surgeon, told Healio/Orthopedics Today. “We have a welcome from myself and the chair, but it is pretty much resident-led so that gives them an opportunity, still virtually, to meet the people in the program and hopefully get a feel for the program.”
She said that applicants receive a document with information on the current residents, including their interests, where they are from and where they went to school, prior to the interview weekend.
“That is information that they may have learned through the social event, but we are trying to help them know more about the program and have a feel for the culture of the program before the interview day because we feel limited in the virtual interview process with that,” LaPorte said.
Because applicants cannot visit the campus and surrounding area, sources said programs have developed virtual tours to give applicants a sense of the environment in and around the institution, either through a slideshow, pre-recorded video or live footage.
“We also incorporated a virtual tour of the city that has been put together by some of our chief residents and different faculty,” Mulcahey, an orthopedic surgeon specializing in shoulder and knee surgery and sports medicine, said. “They incorporated a lot of information about all that is great about New Orleans and the city itself, the program and the different sites where the residents rotate. It gives an excellent overview of what it is like to be a resident and live in New Orleans, albeit a virtual flavor, but still gives the applicants a good idea of what to expect.”
While some institutions kept the interview process the same virtually as it was done in-person, other programs limited the number of staff present during the interview to provide both the applicants and interviewers a better feel for the outcome of the interview.
“We limited our virtual interviews to have no more than two interviewing faculty with one applicant,” LaPorte said. “I think there is a better opportunity for eye contact and, hopefully, sharing visual cues. I think that is helpful as opposed to having too many people in the virtual room.”
Mazzocca, an orthopedic shoulder and elbow clinician, said his institution created standardized questions that are aimed to not only provide consistency between applicants but to lead to more conversation that would provide a better overall picture of an applicant’s personality.
“What we have tried to do is institute where each group asks a standardized question just to try to get any kind of consistency between all the different groups that interview,” Mazzocca, Section Editor of Basic Science & Technology for Orthopedics Today, said. “In other words, teach me something, tell me a big disappointment and how you overcame it, define grit. We will have a standardized question that the interview group can ask the applicant and that way, later, we can evaluate that together.”
Despite the challenges that may occur in setting up virtual interviews for residency and fellowship programs, LaPorte noted the platforms available can help keep the programs organized and efficient by keeping the interviews on time. However, she said the firm stopping point of virtual interviews can be a drawback.
“If you were in a great lively conversation that sometimes takes a little bit of time to get to in person, you could finish that [conversation], even if somebody is knocking on the door,” LaPorte said. “Whereas the virtual interview literally will cut people off mid-sentence because it is programmed. Nobody is doing that manually.”
Applicant, program cost savings
The main advantage for applicants when it comes to virtual interviews is that they do not have to travel, which leads to both cost and time savings, according to James J. Purtill, MD, professor, vice chair and residency program director at Thomas Jefferson University, Sydney Kimmel Medical School, Rothman Orthopaedic Institute.
“The expense and the logistical nightmare of traveling all over the country essentially every weekend over a several-month period of time for busy applicants is gone and we cannot ignore that is a substantial thing for a lot of these medical students,” Purtill told Healio/Orthopedics Today. “Many of them are in significant debt because of medical school expenses, because of their living expenses, and adding a substantial expense of travel every weekend for months all over the country is substantial.”
Programs may also experience cost savings in the residency and fellowship virtual interview process because they do not have to offer meals to applicants during the course of the interview day or spend money on social events, according to LaPorte.
“I think the estimate for programs was a savings worth around $3,000,” LaPorte said. “I am sure that varies from $3,000 to probably $8,000 or $10,000 depending on the program and the location that it is in, whereas for applicants it can be $15,000 [in savings].”
More interview opportunities
Virtual residency and fellowship interviews also provide applicants with the opportunity to interview at a greater number of programs, sometimes even interviewing at two programs in 1 day, according to John A. Scolaro, MD, MA, chief of orthopedic trauma, residency program director and associate professor of orthopedic surgery at the University of California, Irvine.
However, Mulcahey said the opportunity to interview at more programs can also lead to middle-tier students receiving fewer interviews compared with students in the highest tier.
“Since interviews have been virtual for the past couple of years, some students may hold on to more interviews than they really need,” Mulcahey said. “Everybody who is applying wants to match and they think if they interview at more programs, then they have a higher chance of matching.”
More applicants applying to more programs can also lead to an increase in the amount of work for the residency and fellowship program coordinator and faculty, Purtill said.
“[S]cheduling all of [the virtual interviews] and adapting to these changes has been a challenge,” Purtill, a specialist in hip and knee replacement surgery, said. “It is doable, we have gotten used to the idea and the systems to get all of this stuff set up, but, on the whole, it has been more work, especially for a program coordinator, but also for the faculty and myself.”
Challenges in prescreening
Scolaro said the recent increase in applicants has made prescreening more challenging, as well.
“We saw hundreds more applications this last year than we saw even the year before because applicants know they do not have to travel, it is not going to cost them anything, the only challenge is potentially scheduling conflicts and so they have started to apply everywhere,” Scolaro, an orthopedic traumatologist, said.
This has led some programs to put a greater effort into prescreening program applicants, according to Scolaro, who said his program interviewed the fewest number of applicants during the 2021 to 2022 residency cycle than previous years.
“We put more time upfront identifying those people who we thought would be a good fit for our program and focused our efforts on that group,” Scolaro told Healio/Orthopedics Today. “The [virtual interview] process was new to us the first time around, but the second time around, knowing a little bit more about how things shook out in the end, our program ended up interviewing less people than we ever had for the same number of responses.”
Implementing of signaling program
For the 2023 residency cycle, orthopedic programs and applicants will have the opportunity to participate in a supplemental application to the Electronic Residency Application Service application, known as signaling, according to the American Orthopaedic Association.
Utilized in other specialties, the American Orthopaedic Association noted signaling allows applicants to demonstrate a genuine interest in a residency program and is intended to add value to both applicants and programs, which will result in a more equitable, reproducible, efficient and mutually optimal match. Applicants who participate in the signaling program will assign up to 30 preference signals of equal weight to residency programs of their choosing, which will be visible in the supplemental application of the Electronic Residency Application Service application. Programs will receive a list of applicants who have signaled them.
“Now, for the first time, applicants are going to have to identify their top 30 programs pre-interview that they are thinking about, and it is going to be interesting to see how programs react to that,” Scolaro said. “What is the percentage of applicants who have not earmarked them that they are going to interview? If you are a program and you see an applicant and you like him or her, but they have not placed a signal on that application for your program, what is the incentive to interview somebody who you know may already not have a deep interest in your program?”
Identify ‘a good fit’
If residency interviews remain virtual, the signaling program may also help residency programs more easily identify applicants who may be a good fit for their program, which Purtill noted can be hard to do through a virtual interview. Similarly, despite attempts to provide applicants with a feel of the culture of the program, Purtill said the virtual interview does not provide applicants with the best view of how the faculty interacts with other faculty and residents, the physical plan of the hospital or what that particular section of the city is like.
“The purpose of the interview is to review those personality traits and whether or not the applicant is going to be a good fit for the program and, from the applicant’s perspective, whether or not the program is going to be a good fit for them, and it is these intangibles that I think are lost [with the virtual interview],” Purtill said.
Another option that residency and fellowship programs may offer in the future is the chance for a hybrid interview process where applicants have the opportunity to attend the residency or fellowship interview either in-person or virtually.
“I think that this hybrid model is a real possibility,” Mulcahey said. “It has not, in either the orthopedic residency application process or fellowship interview process, been formally decided and no standard has been set, but I think we have seen some of the benefits of the virtual interview and that a hybrid option is a distinct possibility. I think over the next year or so we are going to figure out how that may fit in.”
Hybrid interview option
Currently, for the 2022 to 2023 interview cycle, the AAMC strongly discourages hybrid interviewing within the same program, stating that a hybrid approach may “disadvantage applicants who interview virtually and could further exacerbate inequities if applicants from disadvantaged backgrounds interview virtually at a higher rate due to financial constraints.” The AAMC also noted that not only did published research show that interviewees had lower performance ratings for virtual interviews vs. in-person interviews, but that program directors may perceive applicants who choose a virtual interview option as being less interested in the program.
“I worry about a hybrid process in that I would not want someone to have an advantage just because they were able to have an in-person interview because then that creates a situation where there will be pressure on applicants who perhaps cannot afford it to find a way to get there for an in-person interview,” Purtill said. “Just from a fairness perspective, it should either be all in-person or all virtual. Having a hybrid option for selected individuals may undermine the integrity of the match process as it exists.”
Despite the advantages associated with a virtual interview process, sources who spoke with Healio/Orthopedics Today said these advantages do not outweigh those of the in-person interview. However, sources also said they believe virtual interviews are here to stay in some capacity and may still have a place in the residency and fellowship interview process.
“I think virtual interviews are here to stay in some way, shape or form for a long time,” Scolaro said. “I honestly do not know if we will ever go back to full in-person interviews for medical residency training completely. I think there is always going to be some option for applicants to interview virtually and that is just the world that we are in.”
- AAMC interview guidance for the 2022-2023 residency cycle. www.aamc.org/about-us/mission-areas/medical-education/aamc-interview-guidance-2022-2023-residency-cycle. Published May 16, 2022. Accessed July 7, 2022.
- American Orthopaedic Association endorses preference signaling for residency applicants. www.healio.com/news/orthopedics/20220406/american-orthopaedic-association-endorses-preference-signaling-for-residency-applicants. Published April 6, 2022. Accessed July 5, 2022.
- Bhardwaj P, et al. Plast Reconstr Surg Glob Open. 2020;doi:10.1097/GOX.0000000000003389.
- Final reports and recommendations for medical education institutions of LCME-accredited, U.S. osteopathic and non-U.S. medical school applicants. www.aamc.org/system/files/2020-05/covid19_Final_Recommendations_Executive%20Summary_Final_05112020.pdf. Published May 11, 2020. Accessed June 29, 2022.
- Important information for orthopedic surgery residency programs and students. www.aoassn.org/ume-gme-resources/. Published April 12, 2022. Accessed July 5, 2022.
- Meyer AM, et al. Cureus. 2022;doi:10.7759/cureus.26096.
- Preparing for virtual interviews webinar. www.woa-assn.org/preparing-for-virtual-interviews-webinar. Accessed June 21, 2022.
- Sequeira N, et al. Global Surg Educ. 2022;doi:10.1007/s44186-022-00004-5.
- For more information:
- Dawn LaPorte, MD, can be reached at 601 N. Caroline St., Baltimore, MD 21287; email: email@example.com.
- Augustus D. Mazzocca, MD, MS, FAAOS, FAOA, can be reached at 175 Cambridge St., Charles River Plaza, 4th Fl., Boston, MA 02114; email: firstname.lastname@example.org.
- Mary K. Mulcahey, MD, FAAOS, FAOA, can be reached at 1430 Tulane Ave., New Orleans, LA 70112; email: email@example.com.
- James J. Purtill, MD, can be reached at 925 Chestnut St., 5th Fl., Rothman Orthopaedic Institute at Jefferson, Philadelphia, PA 19107; email: firstname.lastname@example.org.
- John A. Scolaro, MD, MA, can be reached at 101 The City Drive South, Building 29A, Pavilion III, 2nd Fl., Orange, CA 92868; email: email@example.com.
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