Background In response to the COVID-19 pandemic, the 2020–2021 residency interview process will undergo significant changes. Residency programme stakeholders would benefit from knowledge on what students and physicians expect from this process.
Objective The purpose of the study was to describe and contrast the perspectives of student applicants and interviewing physicians related to the residency programme virtual interview process.
Methods A survey consisting of 24 Likert statements was administered across listservs in summer 2020 to physicians (attendings and residents who interview medical students). Medical students also received an anonymous survey and were recruited via email to participate.
Results A total of 155 individuals (104 fourth-year medical students and 51 physicians) completed a survey. Results showed students would prefer in-person interviews over virtual. Residency applicants had high agreement on the limited ability to fully assess the programme and city due to virtual interviews. Individuals with lower step 1 scores had higher agreement on preferring in-person interviews. Individuals in the lowest and highest scoring groups appear more worried about the representation of themselves as a result of virtual interviews. Furthermore, applicants feel that more weight will be placed on steps 1 and 2 scores and class ranks, and they may not be able to fully demonstrate their personality compared with interviewers.
Conclusion The result of COVID-19 has created challenges and subsequent reshuffling of medical education requiring careful preparation and planning. This study provides insight for residency programmes to better understand the applicants’ expectations for the 2020–2021 residency interview and matching process.
- medical education & training
This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.https://bmj.com/coronavirus/usage
Statistics from Altmetric.com
During the COVID-19 pandemic, concerns related to exposure and personal protective equipment have led to the restructuring of medical education. During this time, US undergraduate medical education leaders have discussed methods to provide safe but effective clinical experience for students. In the standard residency application process, students are interviewed in person at 10–20 (or more) programmes around the country.1 This involves significant travel planning, time-off from rotations, and cost to students and residency programmes.
In response to the pandemic, the interview process in 2020–2021 will undergo significant changes. In attempts to limit spread of COVID-19, new policies that restrict visiting ‘away rotation’ clerkships have also transitioned the residency interview process to virtual interviews.2 As a result of this shift, medical student applicants may express concern on their ability to engage, present themselves and feel fully prepared for these interviews.3
As residency programmes prepare for this unique upcoming interview season, residency programme stakeholders would benefit from knowledge on what the students expect from this process. Though some published data have described the perspective of those conducting the interviews (physicians), there is a gap in understanding of student insight, and how these perspectives differ. The purpose of the study was to describe and contrast the perspectives of student applicants and interviewing physicians related to the residency programme virtual interview process.
After Institutional Review Board (IRB) approval by the University of Louisville, an anonymous survey was administered in summer 2020 across listservs to physicians (attendings and residents who interview medical students for residency) via REDCap, a secure, encrypted online database. Medical students also received a similar anonymous survey and were recruited via email to participate; for this, author ST sent an email to all medical students regardless of which medical residency specialty they were applying to within her medical school class in order to gain their respective feedback. Participation in the survey was voluntary for all groups.
The survey consisted of demographic questions as well 24 Likert statements in which respondents rated their level of agreement from 1 (strongly disagree) to 5 (strongly agree). Descriptive statistics were examined to provide sample characteristics. Next, individuals were categorised to determine if differences existed among gender identity or step 1 score group and survey statement. T-tests were conducted to compare gender differences and distinctions between interviewers and students. Analysis of variances (ANOVAs) were employed for comparing responses among step 1 score groups. For any statistically significant findings from the ANOVAs, Games-Howell post hoc analyses were employed to determine the underlying root cause(s) of the significant differences. Statistical significance was set by convention at p<0.05. For comparisons related to agreement differences, 95% CIs are reported.
A total of 155 individuals completed a survey: 104 fourth-year medical students who will apply to residency this year and 51 physicians who conduct residency interviews. Medical student respondents noted they were applying to a variety of specialties including: anaesthesiology (n=8), child neurology (n=2), dermatology (n=4), emergency medicine (n=17), family medicine (n=10), internal medicine (n=7), medicine-paediatrics (n=4), OB-GYN (n=9), ophthalmology (n=1), orthopaedics (n=3), otolaryngology (n=1), pathology (n=2), paediatrics (n=22), psychiatry (n=5), surgery (n=8), or unclear (n=1). Table 1 provides demographic breakdowns for the respective groups.
Medical student feedback
The medical students responded to the 24 Likert questions and provided insight on the key concepts related to virtual interviews and recruitment strategies for residency programmes (table 2). Highest agreement averages were within the themes of (1) virtual interviews not allowing the students to fully understand the city/programme and (2) students would prefer in-person interviews over remote. Lowest agreement was found in students considering applying to more than one specialty as a result of virtual interviews. Table 2 provides results for all statements.
Differences by gender identity
T-tests were conducted to determine differences between women and men on the survey statements. Results showed similar agreement levels among 22 of the 24 items with two items showing statistically significant differences. Women had a slightly higher agreement (although the sample showed more total disagreement) average (M=2.49, SD=1.16) on ‘Residency programme Instagram presence is an important part of my process of evaluating programmes’ compared with men (M=2.06, SD=1.06), showing a mean difference of 0.43 (95% CI: 0.00 to 0.87), p=0.049. Women also had a higher average (M=4.53, SD=0.67) on ‘I would watch a video tour of the city of the programme if provided by the residency programme’ compared with men (M=4.06, SD=0.89), showing a mean difference of 0.47 (95% CI: 0.17 to 0.78), p=0.003.
Differences by step 1 score group
ANOVAs were used to determine differences between step 1 score group [(191−220 (n=37); 221−240 (n=37); 241+(n=29)] and survey responses. Results showed that the majority of statement items (21 out of 24) had similar agreement across step 1 score cohorts, with three items showing statistically significant differences. For these three items, Games-Howell post hoc analyses were conducted to determine differences. For the first item, ‘I would prefer in-person interviews over remote interviews’, there were statistically significant differences (p=0.045). Post hoc analyses showed the group with the lowest step 1 score (191–220) had the highest mean (M=4.68, SD=0.53) which was higher than the highest score step 1 group (M=4.45, SD=0.78) and statistically significantly higher than the group scoring 221–240 (M=4.24, SD=0.86) showing a mean difference between these two groups of 0.43 (95% CI: 0.03 to 0.83), p=0.031.
The next item, ‘I believe as a result of remote interviews I will experience less stress than I would if I had to travel for interviews’, showed statistically significant differences (p=0.007). The lowest step 1 score group had lower average agreement (M=2.59, SD=1.21) compared with the middle group (M=2.67, SD=1.03) and statistically significantly lower scores than the highest scoring group (M=3.38, SD=0.86); the mean difference between the lowest and highest scoring step 1 groups was −0.78 (95% CI: −1.40 to –0.17), p=0.009.
Finally, the third item ‘I fear/think the virtual interviews will not present me in the best light’ showed statistically significant differences (p<0.001). On this item the lowest scoring group had the highest average agreement (M=3.84, SD=1.01) compared with the middle scoring group (M=2.97, SD=1.04) and the highest scoring group (M=3.69, SD=0.81). Post hoc analyses revealed that the middle scoring group had statistically significant lower scores than the lowest step 1 score group with a mean difference of −0.86 (95% CI: −1.44 to –0.29), p=0.002. Furthermore, the middle scoring group also had lower scores than the highest scoring group with a mean difference of −0.72 (95% CI: −1.27 to –0.17), p=0.007. On this item, there were no differences between the lowest and highest scoring respective groups.
Physician insight on virtual interviews
Next, we examined physicians’ responses to 24 Likert questions related to virtual interviews and recruitment strategies for residency programmes (table 3). Highest agreement averages occurred along the theme of virtual interviews not allowing the students to fully understand the city and the programme. Lowest agreement was noted in (1) students preferring group video interviews and (2) that students would prefer remote interviews versus in-person. Table 3 provides results for all statements.
Comparing the interviewers with the interviewees
While the surveys were slightly different (see table 2 vs table 3), the underlying measures were similar enough to allow comparison of perception differences between residency applicants and interviewers. Table 4 shows multiple statistically significant differences in responses.
This study provides insight for student applicants, residency directors and administrators who guide medical students through the interview process. Scant data have addressed optimal recruitment strategies, student mindsets on virtual interviews and plans for the residency application season. This survey showed that students would prefer in-person interviews over virtual. However, with COVID-19 restrictions mandating virtual interviews, residency applicants would prefer individual interviews as opposed to group interviews. Residency applicants had high agreement on the limited ability to fully assess the programme and city as a result of virtual interviews. Individuals with lower step 1 scores had higher agreement on preferring in-person interviews, and as a result of virtual interviews, may be more stressed. Individuals in the lowest and highest scoring groups appear more worried about the representation of themselves as a result of virtual interviews compared to the middle scoring group. Comparisons between interviewers and applicant students yielded multiple differing viewpoints. Applicants feel that they may not be able to fully demonstrate their personality compared with physicians’ perspectives. Also, applicants feel more weight will be placed on steps 1 and 2 scores and class ranks as compared with interviewers. Interviewers were more likely to believe students would apply to and rank more programmes, compared with applicants. Finally, viewpoints differed on recruitment strategies, as social media presence may not be as highly valued by applicants as residency programmes thought.
The complexity of the pandemic and subsequent restructuring of medical education necessitates critical planning. This difficulty especially affects fourth-year medical students, most of whom had to reschedule high-stakes examinations, as they finalise required assessments and seek residency positions.4 Residency programmes must use evidence to guide virtual interview logistics. Residency programmes (including their faculty, residents and so on) may engage in virtual networking events and expand their virtual/social media presence.5
While the challenge of residency interview planning is unique, it is one of many transformations medical education is currently confronting. Proper procedures for administration of offsite examinations, the assurance of students’ exposure to a variety of required diagnoses, the overhaul (and effective cancellation) of many electives and internship opportunities, trends toward video-conferencing for meetings and lectures, avoidance of simulation labs, and many more alterations have been implemented. While we must not forget the main focus of patient care, it is critical to continue to provide the best medical educational experiences, including residency interviews. With the 2020–2021 residency interview season approaching, programmes must continuously evaluate what works and what does not, making changes along the way.3 We can provide positive experiences for students while adhering to rigorous standards.6
Though challenging, the overhaul of the accustomed model of residency application may present opportunities for programmes. Virtual interviews could provide more access and equity for all students.7 With a substantial amount of time and resources required for in-person or virtual interviews, leaders will benefit from making evidence-based decisions on how to allocate resources. Thus, we can ensure that interviews benefit programmes, students and eventually patients.8
In consideration of the findings within this study, some recommendations for residency programmes as they prepare for virtual interviews in the future include:
Provide individual interviews over group interviews when possible.
Increase opportunities for applicants to fully understand the programme such as development of marketing materials on the programme and city of programme that are easily accessible for the applicants to gain better perspective on what the programme offers and how it differs from others.
Understand that individuals may have varying levels of stress as they approach virtual interviews compared with in-person interviews.
Be transparent with applicants on the weighing of application measures such as test scores.
Consistently seek out and use feedback from applicants on what is working well and what needs improved on to optimise the quality of the (virtual) interview process.
Our sample for this survey research was modest, lacking power, and most students were from one institution, limiting generalisability. While we did include students applying to and physicians interviewing for a variety of specialties, we did not make comparisons to see if differences occurred by specialty or by faculty rank; thus, future work could examine medical discipline associations or by faculty rank. Additionally, there were interesting findings such as those scoring highest on step 1 feeling that interviews may not present them in the best light which cannot be fully addressed within this work. Future work, using a qualitative approach, may yield important insight as to why these perceptions occur. Finally, our study sample did not include strong representation across different race/ethnicity groups. Future work should include a larger and more diverse sample to determine differences across groups given that individuals experience uniquely different challenges during interviews.
This study provides insight into how applicants, programme directors and physicians feel virtual interviews will impact the residency interview and matching process. The result of COVID-19 has created numerous challenges and subsequent reshuffling of medical education which requires careful preparation and planning. By understanding the perceptions outlined in this study, residency programmes can better understand the applicants’ expectations for the 2020–2021 residency interview and matching process.
COVID-19 has impacted residency interview season.
Applicants’ and interviewers’ perspectives differ on many items.
Knowing how these perspectives differ can help plan accordingly for interview season.
Current research questions
Describe the perspectives of student applicants and interviewing physicians related to the residency programme virtual interview process.
Determine if there are differences between the perspectives.
What is already known on the subject
COVID-19 has impacted many aspects of medical education.
Residency interviews have moved to virtual.
Alyssa Thomas, Research Coordinator for Emergency Medicine.
Contributors JS developed survey questions, analysed data and wrote the initial draft. MP developed the idea with MH and revised the manuscript. ST helped with survey questions and survey administration. MH developed the idea with MP and revised the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Data availability statement No data are available.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.