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Friday Jun 05, 2020

Virtual Match Has Potential to Drive Innovation

The residency interview process was not what I expected. As a participant in the couples' match, it was far more exhausting than I'd imagined. I attended 18 interviews between October 2019 and January 2020, significantly more than I had planned. I saw 18 hospitals, 18 clinics, 18 workrooms and 18 cafeterias. I heard 18 spiels from 18 program directors. I likely met more than 100 program directors, residents and clinical faculty.

[man and woman emerging from laptop screens to shake hands]

I often felt more confused when leaving an interview than I had before arriving. I spent a lot of time second-guessing what I'd heard or felt.

Why was she looking at me that way?

Did I even answer that question?

Was that in my teeth all day?

Where is my car?

It was an absolute whirlwind in which my partner and I attended 50 interviews in separate states on separate days, every other day for three months. As someone who describes herself as an introvert, I was ready to crawl into a hole and never wear panty hose again. My mental health plummeted during interview season, driven by emotional, physical and mental exhaustion. I was separated from my husband, my friends and my bed (and my cats!) for three months. I couldn't find time to exercise on the road and I wasn't in town long enough to do yoga at my home studio.

Still, when I heard that interviews for the coming season would likely be driven to virtual platforms because of the pandemic, my initial reaction was disappointment.

Disappointment for all the students who, like me, are having to navigate significant changes to their medical training due to COVID-19.

Disappointment that they wouldn't get to have dinner with residents, shake hands with program directors and see their potential new hometowns.

Supporting fellow medical students through this new and changing landscape is always the No. 1 thing on my mind as a member of the AAFP Board of Directors. However, I have come to realize that most of what mattered to me during my ranking process I could have gotten from a virtual interview. In fact, I think both my judgement of programs and programs' judgement of me would have been positively impacted by the use of a virtual platform. In some ways, I think that graduates of the 2021 class will actually experience a more meaningful interview season (if done correctly), and here are some of my biggest reasons why:

  • Virtual interviews reduce white noise. Instead of worrying about how you look and whether your medical school interview suit still fits, you will be able to focus on the content of your interview. I saw some beautiful hospitals during my interview tour, and I saw some less beautiful ones. Frankly, when it came time to rank programs in February, they didn't make any difference in my list. Nor did the aesthetic of the clinic, the proximity of the parking lot or the quality of the cafeteria. Wherever you go, you will have these things, and if you're at the right program they won't matter.
  • Virtual interviews reduce cost. The cost of interviews can be steep. In the couples' match, we applied to more programs than most students in our specialties, but the cost for applications alone was just under $1,000. Then there was an extra fee for couples' matching, fees for the amount of programs you rank, and of course all the money we spent on gas, food and housing while we were away. The interview process has become another exorbitant cost at the end of an already expensive road. It shouldn't cost so much money to get a job you earned a degree to fill. Virtual interviews should prevent cost and distance from being a determining factor in your ability to attend an interview at a program you're interested in.
  • Virtual interviews should reduce interview burnout. I cannot express how exhausting and isolating interview season can be. It's incredibly stressful to plan and organize, but nothing compares to the deluge of the same questions (especially the dreaded "Do you have any questions?") and tours of hospitals that look mostly the same. My hope is that virtual interviews will shift the weight, both for programs and for applicants, to the content of the interviews and the educational experiences provided by each program. I remember the programs that had clinics where I could work in a rural area, treat LGBTQ+ populations, improve my medical Spanish or see incarcerated individuals. I remember talking with individual clinical faculty members I could imagine as my mentors. When I matched at my eventual program, I couldn't even remember what the hospital looked like because it really wasn't an important use of brain space.
  • Virtual interviews could provide a more level playing field. When I was on the trail, I couldn't believe that other students had been in the emergency room that day and left early to get to dinner. I was so lucky that my school gave us adequate time off to attend interviews. However, different schools have different resources and requirements when it comes to interviews, and my hope is that a virtual process will provide a more level playing field. It is inherently unfair that I was able to focus solely on interviewing, while others had to continue rotating. My mental capacity was completely occupied by the Match, and I can't imagine how I would have survived while still being in the hospital.

There will be challenges. I don't want to take that away from anyone. Match this year will be different, and if you're a student matching in 2021, you will never experience the Match like it was before COVID-19. You will have to navigate a new Match, and that will be different and difficult. However, I think the necessity for a virtual Match has the potential to drive innovations that can reduce the burden on students and shift the focus of the interview process to what really matters.

I am proud that the AAFP and other family medicine organizations are advocating for standards across family medicine programs to help ensure a holistic, uniform process for everyone matching in such a hectic environment. The AAFP and other family medicine organizations recently released an open letter(0 bytes) regarding the upcoming match. It includes detailed recommendations to help medical students, residency programs and medical schools through the process.

In the end, you will be great doctors -- physicians who are flexible, hardworking and do their best to provide for their patients and their communities. I look forward to seeing you all rise to the challenge!

Margaret Miller, M.D., M.P.H., is the student member of the AAFP Board of Directors.

Posted at 12:59PM Jun 05, 2020 by Margaret Miller, M.D., M.P.H.

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