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Friday Jul 17, 2020

Despite Challenges, Virtual Match Can Bring Positive Change

Change is the only constant in life. Widely attributed to Heraclitus of Epheseus, that roughly 2,500-year-old adage has taken on a new meaning in recent months -- as change has greatly outweighed routine.

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As residents, we're faced with change on multiple fronts, drastically pivoting patient care to leverage telemedicine and pivoting our learning to virtual didactics and interrupted rotations. Every day brings new change, with updates to testing recommendations and policies and procedures in the offices and hospitals where we work.

And to our medical student peers who will be joining us as residents next summer, it might feel like you're being tested -- by a means no one has had to experience -- before even starting intern year. The pandemic is drastically changing the way residencies recruit and students apply and interview. This advice might sound disingenuous, but I'll say it anyway: Don't worry. We'll get through this together.

We have heard time and time again, "Thank you for your flexibility." But sometimes we happen upon practices that should have been reassessed and transformed previously, and it's only now because of the pandemic that we're being forced to reevaluate processes. As the previous chair of my residency's recruitment committee, I'm realizing that some of the ways we'll be approaching this year's Match should have been considered long ago.

As residency programs gear up for interview season, we have to examine ways to conduct interviews virtually. Some programs have historically offered only virtual interviews, but for most -- applicants and programs alike -- this is all new. Of course, there are fears of the unknown, and at this point it's easier to list the questions than the answers:

  • How will this work?
  • What if I lose my internet connection during an interview? Will that affect my chances?
  • What if I don't have internet access?
  • Do I need to apply to more programs now?
  • How will I get a sense of wellness without seeing the residents in person?
  • How will I know whether I fit in at a program?
  • How will programs know whether applicants fit in?
  • How will a program know whether students fully grasp what makes it unique?
  • How do programs show students they are excited applicants are considering them, and how do programs show students all they have to offer?

I can imagine that hearing about these changes made students feel anxious. But, when I heard about the changes, I was a bit envious! Like Margaret Miller, M.D., M.P.H., my student counterpart on the AAFP Board of Directors, I visited programs around the country during my Match cycle. It was not easy on my schedule or my bank account. I realize now that once you've seen one call room, resident work space or hospital cafeteria, you've seen them all, and they don't actually impact your decision. The things that actually determined my rank list were speaking with residents and evaluating factors such as program values/mission; community involvement; patient population; breadth of training; and opportunities for training in specialized areas like gender-affirming care, family planning, HIV care in the primary care setting and health policy.

Changes in the Match process are also bringing anxiety to programs. But I'm convinced this is going to be a great opportunity for family medicine, and medicine in general, to make strides toward breaking down structural inequities and affording applicants opportunities they might not have previously had when it comes to applying to residency programs.

First, an online interview format can greatly cut down on the stress applicants feel when having to take time away from rotations to navigate travel schedules. Although there are some medical schools that offer protected time for residency interviews, this is not the case at many institutions. Virtual interviews eliminate applicants' travel time and decrease the time they need to be away from a rotation site. From the program perspective, perhaps interview days will be truncated to aid in decreasing computer fatigue and open up resident and faculty member schedules for additional educational endeavors they may have previously missed.

Financially, this is going to make a huge difference for applicants, especially those with debt from medical school and even undergraduate loans. From my perspective helping with residency recruitment, I see the opportunity for significant savings on in-person social gatherings. However, although programs may not anticipate in-person social events, we still need to provide students virtual social interactions. We know the importance of having time with residents without faculty around, and that the less-formal setting of a social event provides an opportunity to get a real feel for the morale at a program. With that, I am hopeful we will see innovative ways for programs to maintain this portion of the interview experience to help provide applicants with all the information they need to decide what suits them.

As a graduating member of my residency program's recruitment team, I can honestly say that programs care about you and want to find the perfect fit -- for you and for the program. Many programs are contemplating how to assist people who may not have ready access to a computer or the internet, including the following challenges:

  • planning interview days to allow people from both coasts to join at reasonable hours.
  • determining the best way to have independent face time with residents several times throughout the process and
  • figuring out innovative ways to make applicants feel welcomed and excited.

This is the first time most programs will be interviewing virtually, so there are bound to be hiccups and a multitude of learning opportunities. But we have learned in the time of COVID-19 that we must be quick to recognize when processes are not working as intended and then do the work to pivot and make changes.

Despite many states having reopened businesses and government operations, the reality is that we are still in the middle of a pandemic in which safety is key. So although I think it is vital for programs to offer only one type of interview -- either all virtual or all in-person -- to ensure equity among applicants who are interviewing, my hope is that the graduate medical education community can commit to a completely virtual approach for applicant safety and fairness. (The AAFP and other family medicine organizations are recommending all virtual interviews in Match guidance for programs and students.)(2 page PDF) Offering only virtual interviews could eliminate applicants' concerns that they need to travel across the country to avoid being ranked lower because they did not opt to do in-person interviews. This could also offer an added sense of relief for applicants who should not assume the risk of traveling during a pandemic (for medical or other reasons) because not only will they not feel pressured to attend an in-person meeting, but also will not feel pressured to disclose why they cannot travel.

While the graduate medical education community works to figure out how to best conduct an entire interview season virtually, there are things that won't change that applicants should consider: location, board pass rate, where residents go after they graduate, population served, curriculum and more. If you are not given the opportunity to meet with residents throughout your interview, I highly recommend you ask programs to provide you with contact information for residents you can speak with individually. After being a part of the recruitment and interview process for the past three years at my program, I can say that this is where many real questions about the programs get asked -- an answered.

You can turn to the AAFP's Strolling Through the Match(99 page PDF) and COVID-19 Match resources(4 page PDF) for more advice.

I am certainly eager, like everyone involved, to see how virtual recruitment and interview season turns out. It may be rocky at first, but I believe it will be a start to improving the Match process for applicants. Isn't that what trainees have been looking for?

Best of luck to everyone this Match cycle. I know that we who came before you will never understand exactly what you are about to go through. But we are here for you and wish you the best. We know that you are going to do wonderfully during this time and will rise to become the best family physicians you can be. We look forward to welcoming you to the family and will be here with you every step of the way.

Kelly Thibert, D.O., M.P.H., is the resident member of the AAFP Board of Directors.

Posted at 12:15PM Jul 17, 2020 by Kelly Thibert, D.O., M.P.H.

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