As mid-exam medical students begin to turn to residencies, schools whose application processes have gone virtual must decide how best to interview applicants in a now safer world for travel.
Most schools currently offer the choice of virtual interviews, in-person interviews, or a mix of the two. In-person interviews were once a given, but the advent of virtual interviews has left schools wondering how their interview processes might benefit some students over others. Although data is sparse, professional organizations have taken strong positions, although none of their guidelines are binding.
In recent directions for the 2022-2023 residency cycle, the Association of American Medical Colleges (AAMC) has recommended that all interviews remain virtual, noting that they “enhance fairness by eliminating a substantial portion of the cost of applying and opening up opportunities to applicants who may have otherwise declined an invitation to interview due to financial constraints.”
The organization strongly advises against hybrid interviews. “Using a hybrid approach could disadvantage candidates who interview virtually and could further exacerbate inequalities if candidates from disadvantaged backgrounds virtually interview at a higher rate due to financial constraints,” they said. written in their advice.
Meanwhile, the American Association of Colleges of Osteopathic Medicine (AACOM), appealed all residency programs to move toward a hybrid model, which they believe will give both DO students and historically underrepresented students a choice in how to present themselves. But not everyone agrees that the option will help students of osteopathic medicine, let alone underrepresented and minority groups.
The move to virtual
Before the pandemic, students applying for residencies might have had a screening call, but they actually all had to travel for in-person interviews at their first-choice programs. The median number of interviews offered and attended in 2017-19 was three, but more than 20% of students attended four or five. In-person interviews not only allow schools to assess the suitability of potential residents for the program, but also allow students to see where they might spend the next half-decade of their lives.
However, this all changed in the 2020 and 2021 cycles. Medical schools have eliminated in-person interviews for safety reasons and the Coalition for Physician Accountability issued a recommendation only for virtual interviews. They kept doing it for another year.
Emad Hammode, MD, director of the internal medicine program at Canyon Vista Medical Center in Sierra Vista, Ariz., said making the process entirely virtual allows students from further afield to interview who might not have been able to attend. travel to Arizona in person due to cost or visa issues. . “It opened that door for that population,” he said. “So we welcome more students from different communities now.”
At the same time, there was something lost.
“There’s a lot of body language that you lose in the interaction, there’s a lot of communication that gets lost just by being on Zoom,” Hammode noted, adding that virtual interviews are also shorter. “You are not able to gauge their personality, their qualification, because when you are face to face, you spend a whole day with them, not only you, but also the other residents, the coordinators, the other staff of the hospital.”
DO versus MD
When it comes to the residency sprint, DO students have historically matched lower rates than their medical counterparts. Robert Cain, DO, CEO of AACOM, said MedPage today that there is a historical bias against DO students because their training is seen as less rigorous and that many DO programs are based in rural rather than urban areas.
As a medical student, “if I’ve been at Ohio State for 4 years, I’ve been lucky enough to join surgery clubs, attend other conferences, and things where the surgical faculty get to know me,” he said. “The DO student who came from this small community hospital was not exposed to this, and did not have the opportunity to be seen and people to get to know him.”
In-person interviews would help DO students gain that exposure, according to AACOM, which said it has survey data and direct feedback from students indicating that eliminating the in-person interview option worsens discrimination at against DO and other minority students. DO students who responded to the survey last year, which Cain said involved more than 1,000 participants, most often said face-to-face interviews provided a benefit, helping students get an idea more complete environment, which can lead to lower dropout rates. .
Bryan Carmody, MD, MPH, a pediatric nephrologist at Children’s Hospital of The King’s Daughters in Norfolk, Va., and an advocate for medical students, said that while DO students aren’t disproportionately from minority backgrounds, they often come from low-income settings than medical students.
However, match rates for DO students were better than ever this year. According to National Resident Matching Program According to the 2022 report, 91.3% of DO graduates matched (compared to 92.9% of MD graduates), compared to 89.1% in 2021. This suggests that standardized virtual interviews may not have hurt their chances.
The case for a hybrid model, Carmody said, rests on the assumption that fewer MD applicants would interview in person — and that’s unlikely. “Do you think DO students will be preferentially attracted to face-to-face interviews and medical students will be relatively less likely to do so? Because honestly, that’s the only way I could see it working consistently. best for students of osteopathic medicine.” he noted.
According to AACOM’s own survey, students overwhelmingly responded that in a scenario where both options were offered, the in-person candidate would have an advantage. “Someone who takes the time to interview you in person, when given the choice of a virtual option, they tell you that they are very interested in the program. And the programs want that,” Carmody said.
“Medical students will perceive the same, all students will perceive the same, and it will only create another arms race,” where applicants willing to pay to travel have the best chance of a match, he said. he adds.
If DOs have to travel greater distances from rural areas and are already at a slight economic disadvantage, this may not help them anyway.
“This signal of interest comes at a cost,” Carmody said. “It has a cost to get to that place, find a place to stay, take time out of your fourth year.”
Cost and Equity
Cain acknowledged that greater exposure to in-person programs goes against the financial burdens that medical students face unequally.
“There are costs at several points…and we have to be careful about all of them,” he noted.
Mahad Minhas, MD, MPH, radiology resident and unparalleled physician advocate, said he interviewed at 14 schools and spent a total of about $10,000 on flights, hotels and other expenses. He thinks schools will decide how to interview on a program-by-program basis, and that a hybrid approach doesn’t really give a choice.
“The programs are going to do what they want, and the applicants are going to have to follow,” he added. “When you tell the person who is not in power, which is the student, that you have a choice, you don’t really have a choice.”
Instead, Minhas said, schools could do all virtual interviews and submit their ranked list of applicants a month earlier than students. In the meantime, students might have the chance to visit their top picks in person before submitting their own ranking list later. “Students can visit if they wish without worrying about any kind of retaliation or falling lower on the [program’s] rank list if they did not come in person,” he noted.
“It’s just human nature. It’s human behavior,” Minhas added. “If I invite you to my party and you’re like, ‘Oh, hey, I’ll be there,’ but you come virtually, and 10 other people come in person, who am I going to favor? people who are there in person.”