Of the innumerable ways that medical schools and residency programs had to adapt to the Covid-19 pandemic last year, one significant change proved to be the way in which medical students interviewed for residency positions. Historically, the fall and early winter found fourth-year students flying across the country, sleeping on friends’ sofas or in hotel rooms, sometimes exhausted and other times invigorated, all in the name of interviewing for residency. This decades-long practice came to an abrupt halt in 2020, as residency programs transitioned in-person interviewing to a virtual endeavor. The new practice brought challenges for all those involved, but also yielded some unexpected opportunities. In this edition of Macy Notes, I am happy to share with you the perspective of three individuals who were “in the trenches” of the change and can provide a perspective from all sides of this process. They are an associate program director, a dean of students, and a graduate of the Class of 2021 who is now a general surgery intern. Drs. Jennifer Best, James Woodruff, and Jamila Picart share insightful, useful lessons learned and their tips for those going through the virtual interviewing process this year.
From your perspective, what did you see as challenges with virtual residency interviews? What were the unexpected victories using virtual interviews?
James Woodruff, Dean of Students, University of Chicago Pritzker School of Medicine: The challenges fell into three categories: technical, interpersonal, and informational. Technically, students experienced challenges regarding the adequacy of their internet access, computer hardware, and lighting/setting. These difficulties were identified well before the interviews started and were relatively easily addressed. Interpersonal challenges were less apparent prior to the interview season. My impression is that quieter students and students who take some time to “warm up” during interviews had even more difficulty with virtual interviews than in-person. Overall, programs did a good job providing information to students, but it is hard to gain perspective on a program’s culture and setting through a virtual interview day.
The virtual nature of the interview season saved our students large amounts of time and money. Without the need for travel, students were better able to pursue education and scholarly activities during the interview season. The average financial burden of student interviews was down 75% compared to in-person interviewing.
Jamila Picart, applicant/interviewee and current intern in General Surgery, University of Michigan: I want to begin by offering a word of encouragement for those going through virtual interviews. This truly is a wonderful time to connect with future colleagues, meet potential mentors, and find your next training home.
That being said, one of the challenges I faced during the virtual interview season was maintaining the interview mindset. On the medical school interview trail, traveling to new places and interviewing in spaces I’d never been to prior was a bit stress-inducing, which is not necessarily a bad thing. Sitting at home and interviewing from my dining room table, it was much easier to slip into a more relaxed mindset or be pushed out of the interview mindset when alarms or little incidents occurred, such as my foster dog finding his favorite squeaky toy during a faculty interview. To establish the interview mindset, I always dressed up from head to toe in interview attire, I pre-packaged snacks for the interview session to limit moving around my home, and when incidents occurred, I gave myself grace (know that your interviewers will as well).
Another challenge I had, which impacted my ranking of the programs, was assessing the larger hospital community, including the patient community. These aspects are equally important to your experience as a resident. Residency programs do not exist in isolation. We are members of a larger team of physicians, other healthcare providers, and essential staff to the hospital. Hospital values and culture shape how you as a resident interact with the rest of the hospital, shape the learning environment, and can create an additional layer of support outside of your residency program. To get a grasp of the hospital culture, I would attend webinars for institutions that were offered broadly to all applicants regardless of specialty, look for online DEI resources, and reach out to current residents.
One of my favorite unexpected victories of the virtual interview season, besides saving money from not having to travel, was being able to actively participate in my medical school community while interviewing. I generally fill my wellness bucket by interacting with my community, both patients and students. And so, when Zoom fatigue wore down on my spirits, it was so wonderful to leave the interview and the interview mindset as soon as I closed Zoom. I could move on to a walk with a friend, a virtual school get-together, or spend time within my community.
Another unexpected victory was the ease of following up with potential mentors and residents outside of the interview session. The virtual format of interviews lent itself more fluidly into continuing conversations later in the same format. I was able to establish better relationships with potential faculty and potential co-residents by continuing interesting conversations or asking new questions via Zoom rather than by email.
Jennifer Best, Associate Program Director, Internal Medicine, University of Washington and Associate Dean for Graduate Medical Education, University of Washington School of Medicine: As you might expect, there was a significant amount of trepidation among program directors regarding the pivot to a virtual recruitment season. First, this major change happened with short notice, amidst the chaos of the pandemic, which itself demanded emotional bandwidth and extra resources. Secondly, we heard a fair bit of concern about whether the “feel” of a program—ultimately a deciding factor for many—could translate to a virtual format. There were suspicions that many students might opt to stay at their medical school for residency without this important data point, especially when evaluating programs in locations they had never visited.
Most of the program directors I’ve spoken with feel that the virtual interview residency selection process was more successful than anticipated, both in its Match outcomes and in its decreased cost (both dollars and time) to applicants, which felt like a very positive and necessary change to enhance equity for all students. During a time when institutions were challenged by COVID, there were also significant savings to programs and departments. Program directors at-large did not feel that their ability to interact with or learn about applicants was shortchanged. Following the experience, many feel this is a change we should make for good.
Understanding the culture of a residency program is important. How did you assess the culture or learning environment of the programs where you interviewed?
Dr. Picart: Talking with my classmates during the interview season, we were very concerned that culture would not transmit through Zoom. I do believe that culture is best assessed live and in-person, but there are ways to get a better grasp for a residency’s culture in the Zoom era. Talking with current residents at the programs you’re interested in, reaching out to trusted resident mentors at your home institution about their experiences when interviewing, connecting with potential personal and academic mentors associated with the program of question, and reviewing resources developed by the program (social media can be a very useful tool to assess program values and community) were methods I used to assess culture. Surprisingly to me, when it was time to create my rank list, I felt confident in my assessment of each program’s culture and whether it aligned with my values. As you get more comfortable with the virtual interview process, you’ll begin to pick up on moments, such as the way a resident describes their typical day or their co-residents, that help you to discern whether you would thrive in their culture or learning environment. And always lean on your colleagues, new friends you meet on the interview trail, or old friends, to help discern your thoughts on a residency program’s culture.
What did you learn from this process?
Dr. Best: We learned that there is a benefit to programs when institutions support recruitment efforts centrally. For our institution, these initiatives included a pair of videos introducing the institution and the city to those who were unfamiliar with life in our part of the country. Our programs could not universally afford to produce such materials on their own and were grateful to have access to them from a central resource. A second initiative was spearheaded by our remarkable Network of Underrepresented Residents and Fellows, who hosted several institutional open house events for diverse applicants across programs. We were reminded that an essential component of recruitment for students is the opportunity to interact with current residents. Programs must allow for this in some way, and ideally, without faculty present. We heard from many applicants that inviting residents to Zoom-in to recruitment day from settings around the hospital, clinics, and labs (with the interviewee privy to spontaneous resident-resident/resident-faculty or staff interactions) provided a window into a culture that they may not have had on a standard tour. The recruitment pages on program and institutional websites have also taken on new importance and may be worth revisiting in this new era, with attention to highlighting the resident voice and experience. Finally, it was helpful for our many program directors to share best practices with one another.
Dr. Woodruff: The experience highlighted the importance of strong communication skills and adaptability to the residency application process.
What advice would you share with students who are interviewing for residency this year?
Dr. Best: First of all, be yourself! You have been invited to interview because of your unique life story, skills, accomplishments, and goals. Trust that you will still shine virtually. Control everything that you can control within the virtual format: your presentation and preparation, the quality of your video and audio, and your surrounding environment. This includes accounting for Zoom fatigue, which is very real and can be apparent to interviewers. Consider scheduling your interviews with adequate breaks in between. Take advantage of the extra offerings programs have put into place to highlight aspects of their curriculum, culture, or setting. In most cases, these are not required, but reflect a deep desire on the part of programs to show you what they believe differentiates them from others. Seek feedback from your newly matched interns about the process. Finally, if you feel you lack important information that will help you make a good decision, please ask! Program directors, faculty, staff, and current residents are eager to support you.
Dr. Woodruff: Students should pursue virtual mock interviews with faculty experienced in interviewing at their home institution. They should actively seek feedback on technical (ex. lighting, framing, quality of equipment), interpersonal (ex. mannerisms, clarity, non-verbal communication), and informational (ex. response content, level of detail, and organization) dimensions of the interview.
- Take care of yourself. Virtual interviewing is hard. At times, you will feel completely drained from sharing your passions and from feeling constantly assessed. Take time to continue the activities that bring you joy.
- Do not second guess yourself. Present your most authentic self. I often would perseverate on interview moments where I did not feel that my values and a program’s values aligned. This is not a deficiency on your part or theirs. Instead, this might just be a sign that a program might not be a right match for you, no matter how prestigious the program.
- Reach out if you have questions or need help. I am so grateful to the residents and mentors who sat with me and gave me honest advice throughout the process. Find those people in your community and along the interview trail who you can lean on.