Journal of the American College of Surgeons - July 2021
Virtual Interviews: An Imperfect Solution to Address Inequity
Caleb Haley, BS, Shane D Morrison, MD, MS, Paris D Butler, MD, MPH, FACS 2021-06-16 01:48:43
In the article, “Virtual Interviews for Fellowship and Residency Applications Are Effective Replacements for In- Person Interviews and Should Continue Post-COVID,” Wright1 discussed how the COVID-19 pandemic resulted in residency and fellowship interviews shifting to virtual formats. The author mentioned several benefits and challenges to interviewing virtually and suggested virtual-only interviews be mandated in future years.1 This article contributes to the much-needed dialogue about the inequities associated with traditional in-person interviewing; however, we believe it is important to consider other factors that might limit residency programs transitioning to a fully virtual model.
The author cited a study showing that despite 89% of fellowship applicants stating that the inability to visit the city and institution was a drawback, 94% of these applicants were satisfied with virtual interviews and 76% of applicants recommended continuation of virtual interviews in the future.2 Although these are promising results, they might not be generalizable to a population of residency candidates. Given that surgical fellowship training generally lasts 1 to 2 years vs surgical residency training, which lasts 5 to 8 years, we believe the inability to visit the location and institution will pose a much greater detriment to residency applicants than fellowship applicants. Several studies describe the importance of in-person interactions when applicants evaluate a program, as well as applicants’ concerns about the inability to physically experience programs’ locations, climates, and cultures.3,4 In addition, there is a suggestion that applicants ethnically underrepresented in medicine might be especially affected by the inability to visit a program in person. In a survey of applicants by Aagaard and colleagues,5 the diversity of a program’s patient population, degree of inclusivity and support of physicians underrepresented in medicine, and the general sense of being wanted were discovered to be especially important factors for applicants underrepresented in medicine; these factors might be difficult to assess virtually.
We also appreciate the author’s perspective about the cost reduction benefit of virtual interviewing. However, we believe virtual formatting does not guarantee equity for all candidates. Applicants traveling to programs to interview ensures a standardized interview setting, but in a virtual interview, perception and performance of applicants can be affected by their physical spaces, technological equipment, and living situations.6 In addition, the Association of American Medical Colleges recently warned that early feedback suggests a maldistribution of interview invitations with top-tier candidates receiving and accepting a greater number of interview invitations than middle- and lower-tier candidates, given lower incentives to release undesired interviews (eg cost and scheduling logistics).7
Although virtual interviews certainly reduce overall cost, they come with their own unique challenges. Rather than mandate virtual interviews for residency programs, we believe a potential solution would be for programs to offer students the choice between an in-person or virtual interview. This solution has been shown to be supported by medical students and would allow individual applicants to make interviewing decisions best suited to their unique circumstances.8 This would require programs to be creative with their interview design and thoughtful with their evaluation process to ensure candidates interviewed in person and virtually are assessed equitably.
REFERENCES
1 Wright AS. Virtual interviews for fellowship and residency applications are effective replacements for in-person interviews and should continue post-COVID. J Am Coll Surg 2020; 231:678—680.
2 Majumder A, Eckhouse SR, Brunt LM, et al. Initial experience with a virtual platform for advanced gastrointestinal minimally invasive surgery fellowship interviews. J Am Coll Surg 2020; 231:670—678.
3 Bernstein SA, Gu A, Chretien KC, Gold JA. Graduate medical education virtual interviews and recruitment in the era of COVID-19. J Grad Med Educ 2020;12:557—560.
4 Kenigsberg AP, Khouri RK Jr, Kuprasertkul A, et al. Urology residency applications in the COVID-19 era. Urology 2020; 143:55—61.
5 Aagaard EM, Julian K, Dedier J, et al. Factors affecting medical students’ selection of an internal medicine residency program. J Natl Med Assoc 2005;97:1264—1270.
6 Seifi A, Mirahmadizadeh A, Eslami V. Perception of medical students and residents about virtual interviews for residency applications in the United States. PLoS One 2020;15[8]: e0238239.
7 Whelan A. Open letter of residency interviews. Association of American Medical Colleges. Available at: https://www.aamc.org/media/50291/download. Accessed January 19, 2020.
8 Davis MG, Haas MRC, Gottlieb M, et al. Zooming in versus flying out: virtual residency interviews in the era of COVID- 19. AEM Educ Train 2020;4:443—446.
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