December 18, 2020, 9:05 am News Staff — With family medicine residency programs roughly halfway through their interview seasons during the COVID-19 public health crisis, AAFP News asked four residency program directors for their insights on the unprecedented, all-virtual Match process necessitated by the pandemic. Here is what they shared.
AAFP News: What were the big challenges for virtual interviews that you expected, and how have you overcome them?
Joyce Hollander-Rodriguez, M.D., Oregon Health & Science University Cascades East Family Medicine Residency: We knew that technology would be an initial challenge, and I’ve seen programs and applicants all getting better at that. We have contingency plans for virtual platforms not working well, for applicants in rural areas with poor bandwidth, or for difficulties with connections. When we have to pivot quickly to using phone for audio or FaceTime for an interview, I’ve seen that happen quickly and with ease. And our applicants are gracious and adept at videoconferencing.
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Kelsie Kelly, M.D., M.P.H., University of Kansas Family Medicine Residency: The big challenge we were expecting was, how do you recreate that personal feel or fit for a program? We have traditionally done a dinner the evening before in-person interviews. Our residents created a virtual meet and greet the night before interview days. I think a lot of programs are doing something similar. I allowed the residents to take that on because it’s a resident thing anyway, or has been in our program, where residents and applicants can have an open forum to discuss things without faculty around.
The other thing – if applicants can’t come to your location – is how do they know what your city is like? A lot of people think Kansas City is more rural than it really is. So we’ve been sending some surprise gift boxes with local Kansas City stuff to let them know who we are. Most of it is food, like barbecue sauce and Russell Stover chocolates.
Leon McCrea, M.D., M.P.H., Drexel University College of Medicine: One of things we want to try to figure out, and it has been hard for us, is how do you recreate the small talk in a virtual platform? How do you let applicants relax and let loose? In a normal interview day there are a lot of informal things, like observing how our applicants interact with residents, faculty and staff. We’re hoping we’re getting some of that, but it’s hard to see as much of folks’ personality in this space.
The other thing that’s been surprising is that the virtual interview is so much easier. There’s not as many moving parts. I literally just show up, sit down in front of a screen, and before you know it it’s over. It’s incredibly efficient, and sometimes I wonder, should I be doing more of this?
The other challenge is that I’ve definitely had anxiety over how many people to interview because with people who don’t have to travel to see me, how do I now they’re serious about my program? If you take a flight to Philadelphia and take a day off to come visit, that says something about your degree of commitment. In this environment, all they have to do is click and hang out for a couple of hours. How do you determine on the front end who is sincerely interested in your program?
Kelly: I would second that. We haven’t had as many cancellations as we usually do, but it’s hard to gauge what is the true interest level.
Will Bynum, M.D., Duke Family Medicine Residency: After absorbing the notion of an all-virtual recruitment effort, the biggest challenge we initially faced was how to convey a complex, vibrant and three-dimensional residency program using what we assumed would be a one-dimensional platform. This challenge has persisted, but we’ve been surprised at the extent to which we’ve still been able to convey our values, ethos and program personality in a dynamic way. That said, we have to work hard to give applicants an inside look at the way we interact with one another, how it feels to spend time in our clinic, and what we mean when we talk about being a family. We’ve done that by creating a fun and laid-back atmosphere in our main Zoom room (we joke around a lot); by being expressive and enthusiastic; and being open and vulnerable: We each share something personal about ourselves with applicants and try our best to be ourselves. I think it’s working so far.
Hollander-Rodriguez: Our program was worried about how to gauge level of interest and commitment to rural family medicine so that after their ERAS applications, we gave them three secondary questions to answer about what we do. For example, “What excites you about rural family medicine?” This allows us to add an extra way of filtering out people who might not be committed to rural training or who might never move to Klamath Falls, Ore.
McCrea: I’m impressed because I can’t imagine the bandwidth it would take to have to read it all. I’m like, oh my gosh, is that more homework?
Hollander-Rodriguez: Yes. It increased our amount of initial work on the application review, but it is part of the holistic application review that we are aiming for. We haven’t had any applicants who made us think, “They’re never going to come here,” which is good.
A big thing that’s important everywhere is how does an applicant get a feel for a place? And that feels really essential in a rural community when you can’t see it or experience it. We put a lot of work together on videos to try to create that feel in other ways.
Bynum: This sounds like a great idea, and I’m noting it for the future. Given the lack of required travel, asking for a bit more information from applicants seems reasonable. Gauging true interest has certainly been difficult this year, especially without the ability to show applicants the best parts of living in our area.
AAFP News: Dr. Hollander-Rodriguez mentioned to me previously that she’s doing a lot more interviews than normal. Is everyone else doing more, too?
Kelly: We typically do 115 interviews. This year we’re doing 130.
McCrea: We normally interview 130-140. This year we will interview 160. I think it’s because of that apprehension about more people interviewing more places because it’s not labor-intensive.
Bynum: We received around the same number of applicants, but the overall quality was higher across the board, hence, a more competitive process. We are interviewing eight to 10 more than last year, but this was more out of our own concern that we may need a broader pool given the uncertainty of this year’s virtual platform. That probably wasn’t necessary, but we’re loving getting to know so many applicants.
AAFP News: What have been some barriers that you did not anticipate, and how have you dealt with those issues?
Hollander-Rodriguez: We’re in rural community, so we’re in that later COVID strain. It’s not yet a full surge, but we’re struggling a little with competing work and the schedule and shifting demands that pulls you way. Normally interview season takes a certain amount of time and energy for residents and faculty, and we are feeling more of that strain of being pulled in too many directions.
McCrea: Interview season is a rallying point in our residency. Having those potential residents coming in every week, everyone coming together and there’s that excitement; We don’t have that energy every interview day now. There isn’t that rallying, coming together and sharing food.
We usually do an end-of-the-season event where anyone who interviewed with us was invited back. It was a big day for the program. All the faculty would be there on a Saturday and all the residents. And there’s not going to be that main event. I want to replicate it because every year we probably match two or three people who come to that meeting.
AAFP News: Out of how many slots?
McCrea: Seven. I know there are going to be people coming that day who are going to end up in my program.
Hollander-Rodriguez: It’s like closing the deal.
McCrea: Yeah. On interview day you see a slice of what we can show you. You have interviews with certain people. But at this event you see the entire faculty and all the residents. There’s food. It’s like a big picnic. I don’t have a way to replicate that on Zoom.
Bynum: I agree. The interview days are highly energizing (and exhausting – Zoom fatigue is real), but the overall season feels like more of a grind than in years past. While virtual recruiting has been hard, I attribute this to much greater challenges, namely COVID-19 and the continued social injustice in our society. In fact (and bear with me here), I see the lack of in-person fellowship during recruitment as like losing a healthy layer of cartilage over a joint surface. Not only is that joint under tremendous strain, but the bone-on-bone friction caused by virtual everything is making it a lot harder to endure. That said, we’re so fortunate to have the opportunity to continue interacting with such great applicants. They’re like little steroid shots every week (I can’t help myself), and we always end the interview day inspired and motivated.
Kelly: My program coordinator has been working on virtual interviews since May. It’s worked out really well for us.
AAFP News: You mentioned fewer cancellations and an easier, more efficient process for virtual interviews. Are there other benefits that you did not anticipate?
Kelly: I’ve been able to assess in my one-on-one interviews what I need to asses, which is nice. I’m still asking the same questions and getting responses. We can chat really well. I think it still allows the introverts and the extroverts to have good conversations.
Bynum: I’ve been pleasantly surprised by how easily I can connect with applicants over Zoom, though I do wonder what this means about how human interaction is evolving. Also, our interview schedule runs 100% on time all day (that countdown timer on Zoom is unforgiving), which makes our program coordinator happy.
Hollander-Rodriguez: Do you feel equally energized after a virtual interview? Like what Leon was saying, it’s a fun, rallying thing. I used to feel a higher level of, “These are cool people doing great things with fresh ideas and really great applicants.” I feel great after being with them, and I still get a feel for them, but it’s not the same interpersonal engagement.
Kelly: We’re in the middle of a big COVID surge, and we’re actually putting in emergency status for GME. I don’t have time for anything else. For me to have to do interviews too, it’s a little rough. We’re doing surge planning and redeploying residents – things that I was hoping we’d never have to do. Everyone is still excited to meet the applicants and hear their stories. I think our residents, however, are missing the renewed sense of community with each other that came with interview season, the lunches together, the excitement of new applicants. With winter, it was always nice to have that time together, and now with the ongoing pandemic, we’re missing that opportunity to engage with each other.
Hollander-Rodriguez: With what you’re going through with COVID, have you thought about cancelling any interviews?
Kelly: I’ve thought about me stepping out of some of them. I’m pretty darn close. One of my assistant program directors can do this once or twice.
Bynum: I’m actually nervous about fewer cancellations by applicants because I’m not sure who really is interested in the program. For better or worse, when students canceled in the past (often because they were understandably running short on travel funds), we at least knew exactly where we stood with them. We also knew that the student who took their place really wanted to come. I really feel for the candidates on our wait list this year, as the likelihood of getting an interview is very low.
McCrea: One other upside is I’ve actually increased the amount of people who can interview for me. They don’t have to physically be there. You could be at another site and another campus or at home. It has decreased logistical challenges. More people have been able to be part of this.
We’re in our second surge in Philadelphia so I feel you in terms of deploying/redeploying, setting up pods, separating your offices so people don’t get each other sick. It’s insane. But other parts have been easier. I thought I wouldn’t get as much insight, but I feel like I get 98.9%. When I do my opening talk, I leave my screen up so I can see their faces, and it’s the same as when I gave it in person. There’s someone staring off into space. There’s someone who’s not laughing at my amazing jokes, and these jokes are tried and true; I know they’re funny.
Kelly: People still show up late. If they were going to be late in person, they’re still late to a virtual meeting.
Bynum: I agree with Leon but can also tell that many applicants have “trained” well for a Zoom interview. This is a good thing, as it shows poise and preparation, but it leaves me wondering if I’m missing nuanced information about how they interact in a more authentic setting, which is so important in the practice of medicine. I also worry about whether applicants are able to sufficiently authentically express themselves on this forum.
AAFP News: Without the restrictions of travel time and expense, do you think you have reached some students who might not have interviewed with you in the past? Based on what was said earlier, maybe there are some positives and negatives to that.
Kelly: There is such a big pool of applicants for us. And we had two new D.O. programs open in town, and this is their inaugural graduating class, so we have a huge number of Midwestern applicants. We’ve had people from all over the United States, so we’ve narrowed it down based on geography and diversity. I haven’t had that luxury before.
McCrea: I have a more intense local pool of applicants. They are applying to places they already know because they can’t get to other places. People have been more transparent in even their written applications about “why Philadelphia matters to me.” I have people say, “I have a fiancé at the University of Pennsylvania; please give me a look.” Overwhelmingly, the process has been good, better than I expected.
Bynum: I do think we’re reaching students who otherwise may not have applied or interviewed. This is likely aided by not having to travel, but I also think we’ve reached new audiences through all of the virtual recruiting we did prior to beginning interviews (Zoom-based informational sessions, a residency video, etc.). It’s almost crazy to think that we weren’t doing any of that in the past.
Kelly: I’m curious about you, Joyce. Being rural, what’s your access to medical students during a pandemic?
Hollander-Rodriguez: We have a rural campus and student rotations through OHSU that are still occurring, but we have not been able to have the usual visiting students.
These students are the ones we actually get to interact with.
I wonder if we may be more likely to match with a group that is more regional. Historically, we’ve gotten people from across the country. We draw that niche of people who want to do full-spectrum rural medicine. This year seems like if you’re on the East Coast and you’ve never been to Oregon, it’s going to be more of a leap of faith to do that. I’ve had more applicants ask, “If I take a road trip in the spring, can I visit you guys?” We have to say, “You can come through and do a self-guided tour, but no in-person interviews means no in-person interviews.”
AAFP News: Assuming that a COVID-19 vaccine returns us to some semblance of normalcy by the 2022 Match interview season, what is the role of virtual interviews moving forward? Will we see some mix of in-person and virtual interviews, or will this likely go back to a mostly in-person process?
Hollander-Rodriguez: I can’t ever imagine being completely comfortable with this from a rural perspective. I could see doing a hybrid where people are given the option of doing a portion of their interviews virtually. For many programs, we may be missing the importance for applicants of assessing a location, the program’s connection to a community and the overall sense of place. This may be particularly relevant for applicants looking at relocating to regions they have never visited or for applicants looking at rural community-based programs.
McCrea: I think if I’m able to I would definitely consider some component of virtual interviews because they work. I need to see what this Match class looks like to see if I’m thrilled.
There’s a part of me that thinks we create an undue burden with the amount of money applicants put out. Most of our applicants visit like 10 programs. In some other disciplines it could be 20 or 30. It’s such a useless expense. There has to be a better way to utilize resources.
I wish my department would reward me the money we’re saving on food. We’re not spending any money on that this year. We’re trying to figure out how to give people a little gift back.
Bynum: I can’t see us not doing virtual interviews in the future because they do seem to work so well. We’ll need to think creatively about how we utilize them, however. I strongly believe that we have to reduce the out-of-control financial burden we are placing on medical students, which is a strong overall driver of lack of equity in our selection processes. Because of that, I’d like to envision a future where we can create true equity between an in-person visit and a virtual visit in terms of chances of matching to our program. This will take work, commitment and creativity.
Hollander-Rodriguez: Are you sending them gifts? We send a small care package to each applicant to try and re-create the feeling of welcome that we had with in-person visits.
McCrea: We’re sending them a little magnet, something that says, “Don’t forget about us.”
Kelly: I worry how much more work it will be if it’s a mix of hybrid or in-person. Are we going to do a first pass virtually and then have them come in? What does that look like? Would that be beneficial? Could I still interview the same number virtually, but reduce it somehow and bring half of them in? I don’t know. I think it will be a mix somehow because the world is too virtual at the moment, and this has gone well for our program.
McCrea: What if we did virtual interviews and then you had two to four days when people just came? There could be a way to say, “Here are one of four Fridays or Saturdays to come and see who we are.”
Kelly: That’s a good idea.
McCrea: It’s not another stressful thing. It’s a chance to come and mingle and …
Kelly: Be a person and let yourself shine?
McCrea: Applicants are not going to go 15 places for second looks. Virtual interviews are going to whittle it down for them, too. “These are the three or four places I’m really serious about. I’ll take time to travel to these places.”
AAFP News: What have you learned from virtual interviews that might improve the in-person process?
Kelly: I learned that our process we had for in-person interviews worked pretty well and translated easily into virtual interviews, so I feel fortunate. I now am even more convinced that a half day for interviews works well; there’s no need for more. I think we’ll probably continue the same format, whether it continues to be virtual or goes back to in-person.
Hollander-Rodriguez: We have definitely gotten more efficient and been able to pare down our residency overview talks to the essentials and our interview days to just a half day. I see us continuing this in the future.
Bynum: Same here; we’re doing two sets of interviews in a single day where we used to require a full day for one set. Totally exhausting days for us but only half the number. We think it’s better for students as well, though I don’t know how we’ll only do a half day in the future if we ask students to travel for a visit.
AAFP News: How are students adapting to the virtual process? What advice would you offer applicants based on what you’ve seen so far?
Kelly: All the same rules still apply: Be professional, be timely, be prepared. But also be flexible, be open to engaging in the virtual world. Applicants should reach out to programs if there are other questions. I think programs are working to be more responsive to the needs of the applicants, given the times.
Bynum: Yes, be on time! It’s much harder to justify being late for a virtual interview. Don’t slam a Big Mac or anything, but do make sure your basic human needs are met: It’s OK to drink, cough or sneak a snack if your blood sugar is tanking. I want you to be a real person because I’m going to be one and do these things during our interview. Also, if something goes haywire and technology conspires against you, make sure you have another way to immediately contact the program. I suggest asking the program coordinator for their cell phone number prior to the interview.
McCrea: This is your presentation. This is the new you, our impression of you. For example, I have lighting behind my camera. I have darker skin so without lighting there would be shadows, and you may not be able to see my face as clearly. Take the time and effort to invest in whatever it is that gives your best appearance. Practice and do a dry run or two. I think you’ll be more confident when you’re interviewing.
Hollander-Rodriguez: It may be difficult for applicants to get a feel for a residency program, the resident-faculty interactions or a sense of community in the virtual format. Post-interview questions and communications may be handled differently this year because of the potential need for more information and more interaction for applicants to make an informed decision. If applicants need more information to help them make a decision, it’s really critical to pursue that.
Bynum: I agree. A thoughtful follow-up email is important this year in particular. Try not to make it token and make sure it’s honest. And don’t worry about bothering me; I want to hear from you, need to know your interest and it’s my job! I would also encourage applicants to do everything they can to be their authentic selves during the virtual visits. Although the medium may not be as authentic, there is still plenty of opportunity for us to get to know you as people. Don’t let virtual recruiting get in the way of that.