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AAIM Guidelines for Interview and Post-Interview Communication for Graduate Medical Education Recruitment

      Perspectives Viewpoints
      • Inappropriate communication during graduate medical education (GME) recruitment continues to be problematic despite clear prohibitions and severe potential consequences
      • AAIM created a task force to create a single set of guidelines for GME recruitment in the internal medicine community.
      • The 3 main components consist of a program statement, mandatory annual training, and structured initial communication
      • Faculty development is an integral part of the success of this initiative, and tools are provided at im.org

      Introduction

      Inappropriate communication during graduate medical education (GME) recruitment continues to be problematic despite clear prohibitions and severe potential consequences.
      • Berriochoa C.
      • Reddy C.A.
      • Dorsey S.
      • et al.
      The residency match: interview experiences, postinterview communication, and associated distress.
      • Sbicca J.A.
      • Gorell E.S.
      • Peng D.H.
      • Lane A.T.
      A follow-up survey of the integrity of the dermatology national resident matching program.
      • Hessel K.
      • DiPasco P.
      • Kilgore L.
      • et al.
      Have we come as far as we had hoped? Discrimination in the residency interview.
      • Hern Jr., H.G.
      • Trivedi T.
      • Alter H.J.
      • Wills C.P.
      How prevalent are potentially illegal questions during residency interviews? A follow-up study of applicants to all specialties in the national resident matching program.
      • Cornett P.A.
      • Williams C.
      • Alweis R.L.
      • et al.
      Problematic communications during 2016 fellowship recruitment in internal medicine.

      Williams CM, Alweis RL, O’Connor A, et al. Inappropriate communication during internal medicine fellowship recruitment: a mixed-methods analysis [epub ahead of print]. Am J Med. doi: https://doi.org/10.1016/j.amjmed.2019.02.013.

      In addition to laws and institutional policies governing employment practices, standards such as the National Resident Matching Program (NRMP) Match Participation Agreement for Applicants and Programs and the Match Communication Code of Conduct outline principles that uphold an applicant's right to privacy and non-coercion.
      • US Equal Employment Opportunity Commission
      Prohibited employment policies/practices.
      • Curtin L.S.
      • Signer M.M.
      program noncompliance in the national resident matching program: prevalence and consequences.
      • National Resident Matching Program
      Code of conduct.
      However, full adherence to all forms of guidance is not mandatory. Whereas programs found in contractual violation of the Match agreement can be permanently barred from future Match participation, non-adherence to the Code of Conduct or the Association of Program Directors in Internal Medicine (APDIM) Statement on Post-Interview Communication and Second Visits (SOPCS) cannot serve as a basis for sanction because they are voluntary for programs.
      • National Resident Matching Program
      Code of conduct.
      • Alliance for Academic Internal Medicine
      Post-interview communication guidelines, 2017.
      In such instances, compliance monitoring, data reporting, and position statements have become common methods to influence program practices.
      Program inquiries into rank-order lists, locations of other interviews, and geographic preferences are widely reported across specialties despite their violation of the Match agreement.
      • Berriochoa C.
      • Reddy C.A.
      • Dorsey S.
      • et al.
      The residency match: interview experiences, postinterview communication, and associated distress.
      • Sbicca J.A.
      • Gorell E.S.
      • Peng D.H.
      • Lane A.T.
      A follow-up survey of the integrity of the dermatology national resident matching program.
      • Hessel K.
      • DiPasco P.
      • Kilgore L.
      • et al.
      Have we come as far as we had hoped? Discrimination in the residency interview.
      • Hern Jr., H.G.
      • Trivedi T.
      • Alter H.J.
      • Wills C.P.
      How prevalent are potentially illegal questions during residency interviews? A follow-up study of applicants to all specialties in the national resident matching program.
      Prompted by similar concerns in internal medicine (IM) during the 2016 fellowship recruitment season, the Alliance for Academic Internal Medicine (AAIM) began conducting a prospective study to assess trends. Results from its 2016 survey, showing that at least 52% of applicants were asked to name other programs to which they had applied, raised the level of concern.
      • Cornett P.A.
      • Williams C.
      • Alweis R.L.
      • et al.
      Problematic communications during 2016 fellowship recruitment in internal medicine.
      Before and during the 2017 fellowship season, AAIM engaged in efforts to educate members through e-mail campaigns. Yet, survey results of the 2017 fellowship applicant pool generally supported previous study findings.

      Williams CM, Alweis RL, O’Connor A, et al. Inappropriate communication during internal medicine fellowship recruitment: a mixed-methods analysis [epub ahead of print]. Am J Med. doi: https://doi.org/10.1016/j.amjmed.2019.02.013.

      Although the survey did not assess the impact of the NRMP violation reporting form, introduced in September 2017 with an option for anonymous reporting, data analysis showed few meaningful differences between the 2016 and 2017 cohorts in reporting of Match agreement violations.
      • Cornett P.A.
      • Williams C.
      • Alweis R.L.
      • et al.
      Problematic communications during 2016 fellowship recruitment in internal medicine.

      Williams CM, Alweis RL, O’Connor A, et al. Inappropriate communication during internal medicine fellowship recruitment: a mixed-methods analysis [epub ahead of print]. Am J Med. doi: https://doi.org/10.1016/j.amjmed.2019.02.013.

      In 2017, 40% respondents indicated feeling pressure to reveal their rank list at least some of the time.

      Williams CM, Alweis RL, O’Connor A, et al. Inappropriate communication during internal medicine fellowship recruitment: a mixed-methods analysis [epub ahead of print]. Am J Med. doi: https://doi.org/10.1016/j.amjmed.2019.02.013.

      Underreporting because of a fear of retaliation likely explains the discrepancy between specialty findings and NRMP data showing only 2 investigations of program coercion from 2013 to 2017.
      • Curtin L.S.
      • Signer M.M.
      program noncompliance in the national resident matching program: prevalence and consequences.
      Alliance surveys also assessed the frequency of questions about relationship status, family planning, sexual orientation, and religion.
      • Cornett P.A.
      • Williams C.
      • Alweis R.L.
      • et al.
      Problematic communications during 2016 fellowship recruitment in internal medicine.

      Williams CM, Alweis RL, O’Connor A, et al. Inappropriate communication during internal medicine fellowship recruitment: a mixed-methods analysis [epub ahead of print]. Am J Med. doi: https://doi.org/10.1016/j.amjmed.2019.02.013.

      Previous GME studies have shown that questions of an intense personal nature are a common feature of interview experiences.
      • Berriochoa C.
      • Reddy C.A.
      • Dorsey S.
      • et al.
      The residency match: interview experiences, postinterview communication, and associated distress.
      • Sbicca J.A.
      • Gorell E.S.
      • Peng D.H.
      • Lane A.T.
      A follow-up survey of the integrity of the dermatology national resident matching program.
      • Hessel K.
      • DiPasco P.
      • Kilgore L.
      • et al.
      Have we come as far as we had hoped? Discrimination in the residency interview.
      • Hern Jr., H.G.
      • Trivedi T.
      • Alter H.J.
      • Wills C.P.
      How prevalent are potentially illegal questions during residency interviews? A follow-up study of applicants to all specialties in the national resident matching program.
      • Cornett P.A.
      • Williams C.
      • Alweis R.L.
      • et al.
      Problematic communications during 2016 fellowship recruitment in internal medicine.

      Williams CM, Alweis RL, O’Connor A, et al. Inappropriate communication during internal medicine fellowship recruitment: a mixed-methods analysis [epub ahead of print]. Am J Med. doi: https://doi.org/10.1016/j.amjmed.2019.02.013.

      In 2016, women were more frequently asked about plans to have children and other programs to which they had applied.
      • Cornett P.A.
      • Williams C.
      • Alweis R.L.
      • et al.
      Problematic communications during 2016 fellowship recruitment in internal medicine.
      No gender differences appeared based on demographic questions in 2017.

      Williams CM, Alweis RL, O’Connor A, et al. Inappropriate communication during internal medicine fellowship recruitment: a mixed-methods analysis [epub ahead of print]. Am J Med. doi: https://doi.org/10.1016/j.amjmed.2019.02.013.

      Still, one-half of all respondents were subjected to questions about relationship or marital status and 1 in 5 to questions about family plans.

      Williams CM, Alweis RL, O’Connor A, et al. Inappropriate communication during internal medicine fellowship recruitment: a mixed-methods analysis [epub ahead of print]. Am J Med. doi: https://doi.org/10.1016/j.amjmed.2019.02.013.

      Qualitative data results included reports from a female applicant who removed her wedding ring to avoid questions about marital status and an international medical graduate who was prompted to engage in discussions about current events in his or her birth country.

      Williams CM, Alweis RL, O’Connor A, et al. Inappropriate communication during internal medicine fellowship recruitment: a mixed-methods analysis [epub ahead of print]. Am J Med. doi: https://doi.org/10.1016/j.amjmed.2019.02.013.

      The NRMP Code of Conduct strongly discourages such questions, as does AAIM, but enforcement by an outside organization would require extensive investigative authority and resources because of the broad scope of these provisions.
      • National Resident Matching Program
      Code of conduct.
      NRMP and APDIM also provide guidance on post-interview communication. The Code of Conduct states that program directors should neither require post-interview communication nor engage in a misleading manner to influence an applicant’s rank-order list.
      • National Resident Matching Program
      Code of conduct.
      The APDIM statement, which only applies to residency recruitment, encourages programs to adopt a uniform post-interview communication policy. In addition to all applicants receiving the same information, post-interview communication should be limited to programmatic facts (eg, number of rotations in the intensive care unit).
      • Alliance for Academic Internal Medicine
      Post-interview communication guidelines, 2017.
      Following release of the APDIM guidelines in June 2014, the number of programs with post-interview communication policies increased; however, rates of applicant contact remained constant.
      • Chacko K.M.
      • Shalini R.
      • Kisielewski M.
      • et al.
      Postinterview communications: two surveys of internal medicine residency program directors before and after guideline implementation.
      The voluntary nature of the policy likely contributed to these results.
      • Chacko K.M.
      • Shalini R.
      • Kisielewski M.
      • et al.
      Postinterview communications: two surveys of internal medicine residency program directors before and after guideline implementation.
      In the 2017 survey, one-half of fellowship applicants did not know program director expectations regarding post-interview communication.

      Williams CM, Alweis RL, O’Connor A, et al. Inappropriate communication during internal medicine fellowship recruitment: a mixed-methods analysis [epub ahead of print]. Am J Med. doi: https://doi.org/10.1016/j.amjmed.2019.02.013.

      More than one-third felt that programs encouraged but did not require post-interview communication. Applicants have raised concerns that post-interview communication contravenes the spirit of the Match and stated a preference for prohibiting post-interview communication.
      • Berriochoa C.
      • Reddy C.A.
      • Dorsey S.
      • et al.
      The residency match: interview experiences, postinterview communication, and associated distress.
      • Yarris L.M.
      • Deiorio N.M.
      • Gaines S.S.
      Emergency medicine residency applicants’ perceptions about being contacted after interview day.
      • Carek P.J.
      • Anderson K.D.
      Residency selection process and the match: does anyone believe anybody?.
      • Jena A.B.
      • Arora V.M.
      • Hauer K.E.
      • et al.
      The prevalence and nature of postinterview communications between residency programs and applicants during the Match.
      • Camp C.L.
      • Sousa P.L.
      • Hanssen A.D.
      • et al.
      Orthopedic surgery applicants: What they want in an interview and how they are influenced by post-interview contact.
      • Holliday E.B.
      • Thomas C.R.
      • Kusano A.S.
      Integrity of the national residency matching program for radiation oncology: national survey of applicant experiences.
      Even thank-you notes can be a source of confusion as applicants and programs both weigh the consequences of not responding in-kind.
      • Frishman G.N.
      • Matteson K.A.
      • Bienstock J.L.
      • et al.
      Postinterview communication with residency applicants: a call for clarity!.
      • Berriochoa C.
      • Ward M.C.
      • Weller M.A.
      • et al.
      Applicant interview experiences and postinterview communication of the 2016 radiation oncology match cycle.
      Many interview etiquette resources about getting into residency recommend sending thank-you notes, which may favorably affect an applicant’s position on the rank list, even if a program indicates they are unnecessary.
      • Frishman G.N.
      • Matteson K.A.
      • Bienstock J.L.
      • et al.
      Postinterview communication with residency applicants: a call for clarity!.
      • Berriochoa C.
      • Ward M.C.
      • Weller M.A.
      • et al.
      Applicant interview experiences and postinterview communication of the 2016 radiation oncology match cycle.

      Le T, Bhushan V, Shenvi C. First Aid for the Match. 5th ed. New York City, NY: McGraw Hill Education/Medical; 2010.

      Katta R, Desai S. The Successful Match 2017: Rules for Success in the Residency Match. Valley Stream, NY:Md2B; 2016.

      UCSF Office of Career and Professional Development/Student Academic Affairs. How to interview effectively (Medicine). Following up: the thank you letter. Available at: https://career.ucsf.edu/medical-students/residency-search/interviewing-effectively. Accessed February 27, 2019.

      • Insider Medical Admissions
      Medical school and residency interview thank you note etiquette.
      In addition, second looks are a source of anxiety and costly for applicants.
      • Brooks J.T.
      • Reidler J.S.
      • Jain A.
      • et al.
      Post-interview communication during application to orthopaedic surgery residency programs.
      Nearly one-half of applicants in 2 specialties reported feeling obligated to return for second looks.
      • Sebesta E.M.
      • Lipsky M.J.
      • Nunez M.
      • et al.
      The national resident matching program code of conduct: what is the perceived degree of compliance during the urology match process?.
      The NRMP Code of Conduct forbids programs from requiring second visits and from implying that returnees would gain an advantage in rank position.
      • National Resident Matching Program
      Code of conduct.
      The APDIM guidelines state that programs should indicate in writing that second visits are neither required nor encouraged and instructs faculty to advise that applicants request a second visit only to help inform rank-list preparation.
      • Alliance for Academic Internal Medicine
      Post-interview communication guidelines, 2017.

      Residency and Fellowship Interview and Post-Interview Communication Task Force

      In response to challenges in the current environment—the frequency of inappropriate and potentially coercive interview and post-interview communication, survey data, and limitations of the residency post-interview communication policy—AAIM sought to effect change by charging a task force to draft new guidelines and development tools for faculty training. The final task force included a mix of AAIM council and committee members. During deliberations from September 2018 to February 2019, members reviewed the literature on inappropriate communication and discussed the effectiveness of current policies before drafting recommendations.
      Several major themes emerged from these discussions. Applicants in IM are not afforded privacy protections and professional experiences during interview activities that they would likely have for a nontraining employment opportunity, even at the same institutions where they interview. Programs neither assume enough responsibility for the conduct of their representatives, particularly for IM fellowships, nor provide adequate training. The current state is not as a result of a few bad actors—the data suggest as much—but rather to an interview culture that has not kept pace with changing applicant expectations and standards of professionalism. Disingenuous and ambiguous language (eg, “ranked to matched,” “my top program”) on both sides reinforces the extent to which gamesmanship has defined modern GME recruitment. Differences in “All-in” participation and specialty match rates are major contributing factors. Habitual questions about family planning or applicants’ other programs are best addressed through clear policies, consistent education, and institutional enforcement. Programs must also be willing to exclude faculty interviewers who refuse training or flout program policies. IM is a highly diverse specialty, in which inflexible position statements such as “no post-interview communication” will severely hamper successful matching efforts for many programs. Only programs that perceive the opportunity costs of adherence as low are most likely to voluntarily oblige. Inclusive and consensus-driven standards are needed for IM to make meaningful gains in professional conduct.

      AAIM Guidelines for Recruitment-Related Communication

      AAIM has adopted the following guidelines for GME recruitment in IM (Table 1). Although they are voluntary, AAIM expects that its member institutions will make every effort to meet these minimum and reasonable standards. The 3 main components consist of a program statement, mandatory annual training, and structured initial communication. Each program should develop a policy that informs applicants and program representatives of its communication expectations and note adherence with the NRMP Match agreement, the Code of Conduct, and AAIM policies. AAIM encourages statements that address the most salient areas of concern in the clearest terms. For example, “A program representative should never ask applicants to divulge or pressure them into revealing rank order lists, family planning, marital/relationship status, other programs of interest, or geographic area of interest.” Before deciding on whether the program will engage in post-interview communication, consideration should be given to the benefits of uniform communication, applicant perspectives about post-interview communication, and best practices to eliminate coercion and inappropriate program conduct when making an offer outside of the Match. The time frame for applicants to make a final decision and the procedure for offering a position should be carefully evaluated before opting for high-stakes post-interview communication. Program procedures on initiating post-interview communication, responding to applicant-initiated post-interview communication, and offering a position outside of the Match (if applicable) should be clearly stated. Applicants are often encouraged to send thank-you cards or e-mails following an interview.

      Le T, Bhushan V, Shenvi C. First Aid for the Match. 5th ed. New York City, NY: McGraw Hill Education/Medical; 2010.

      Katta R, Desai S. The Successful Match 2017: Rules for Success in the Residency Match. Valley Stream, NY:Md2B; 2016.

      UCSF Office of Career and Professional Development/Student Academic Affairs. How to interview effectively (Medicine). Following up: the thank you letter. Available at: https://career.ucsf.edu/medical-students/residency-search/interviewing-effectively. Accessed February 27, 2019.

      • Insider Medical Admissions
      Medical school and residency interview thank you note etiquette.
      Whether programs find this useful (eg, immediately discarded, influences rank position) would be appropriate to place in the program statement. As previously discussed, informing an applicant of a favorable rank position creates confusion. The policy serves as an opportunity for programs to reflect on and consider procedures that engender transparency and uniform interpretability. Though discouraged, highly interpretable and potentially misleading phrases such as “ranked to match” and “highly ranked” should be clearly defined. Programs that engage in post-interview communication may wish to consider the benefits of reserving these expressions for final rank positions that are within the total number of open positions and codify this approach. The policy should include links to additional resources: NRMP Code of Conduct, Match agreement, AAIM policy, and NRMP Violation Report Form for Applicants. Programs may choose to provide a mechanism by which applicants can report concerns anonymously, either separate from or in conjunction with current evaluations. If implemented, applicants should be made aware that any feedback is independent of rank decisions. As set forth by the NRMP, second visits should not be required or implied as beneficial for final rank-list positions. If programs make second visits available for applicants wishing more program information to help with their rank-order list, the program should ensure that its representatives follow the same communication standards, including mandatory training, as established for on-site interview activities.
      Table 1AAIM Guidelines for Interview and Post-Interview Communication for Graduate Medical Education Recruitment
      ComponentsSuggested content
      Program statement
      • Confirm adherence to NRMP Match agreement, Code of Conduct, and AAIM policies
      • State expectations of on-site communication from program representations
        • Describe in the clearest terms the most problematic areas of concern
        • Describe the range of benefits and penalties of individual compliance
      • State that all program representatives involved in interview-related activities must participate in annual training and complete an attestation form
      • State whether the program will engage in post-interview communication
        • Consider the benefits of uniform communication
        • Consider applicant perspectives about post-interview communication and related stress
        • Review best practices to eliminate coercion and inappropriate program conduct, including the time frame given to applicants to make a final decision and the manner in which offer is made.
        • Consider impact of applicants’ time away from training program and logistical burden related to second looks, which the Code of Conduct states should not be required or be implied that participation will impact rank placement.
        If yes, (indent the following bullets more)
        • Describe procedures for program-initiated post-interview communication
        • Describe program expectations for responding to applicant-initiated post-interview communication
          • Define whether post-interview thank-you notes will be used for ranking decisions
        • Define procedures for informing top applicants
          • Define all terms that are open to interpretation
          • Avoid phrases such as “ranked to match” and “highly ranked”
        • Describe procedures for offering a position outside of the Match (if applicable)
        If second looks are available, (indent the below bullet more so it is clearly associated with italicized point)
        • State that second looks are not required or imply second visits are used in determining applicant placement on a rank-order list.
      • Provide links to additional resources
        • Consider benefits of anonymous reporting to program
      Mandatory annual training
      • Use unambiguous language in policy
      • Download and customize AAIM training templates
      • Require annual training of all program representatives—faculty, staff, learners—who will participate in recruitment-related activities
      • Review NRMP Match agreement, Code of conduct, AAIM policies, and program policies on appropriate program conduct
      • Describe range of benefits of adherence for the program and individuals
      • Describe range of negative consequence of non-adherence for programs and individuals
        • Provide data on occurrence and examples of inappropriate communication
      • Provide appropriate questions
        • Consider role-playing or scenario-based instruction
      • Review practices to mitigate differences in communication based on explicit and implicit biases
      • Posting training materials for future reference
        • Consider providing reminder on interview day
      • Require completion of annual attestation
        • Record as activity for faculty or professional development
      Structured initial communication with applicants
      • Develop succinct statement about program expectations around communication with applicants
        • Note adherence with NRMP and AAIM policies
        • State that annual training takes place
        • State where applicants can find program policy
        • Provide a program resource(s) for applicants to discuss concerns
      • Provide paragraph to applicants before the start of on-site recruitment activities
      AAIM = Alliance for Academic Internal Medicine; NRMP = National Resident Matching Program.
      Programs should conduct annual training for all faculty, trainees, and staff who participate in interview-related activities. AAIM does not endorse a specific format (eg, in-person, paper- or electronic-based), but directs that the content cover pertinent internal and external policies/guidelines (eg, Match agreement, Code of Conduct, human resources [HR] policies, AAIM position, the program statement), appropriate questions, consequences for non-adherence (eg, permanent ban from the Match, program reputational damage, applicant stress, civil action), and related survey findings. Integrating perspectives from students, residents and human resources is encouraged. Role-playing or scenario-based training could help faculty with rephrasing problematic questions. Rather than “What is your preferred geographic area?” instructors or peers can ask guiding questions such as, “What attributes do you look for the most in programs?” or “Are there any questions or concerns about our program that I can address?”
      AAIM advises training on responding to applicant inquiries as well. Just as programs seek to gain an upper hand by asking about rank-order lists (in violation of Match agreement), applicants likewise inquire about their position on program’s rank-order list (not in violation of the Match agreement). It is in the program’s best interest to provide language to all interviewers on responding to common applicant inquiries. All training materials should be made available for future reference. Written or verbal reminders each interview day can reinforce training. Qualification to participate in interview-related activities each year should be contingent upon having taken part in training and signed an attestation form to abide by expectations. The Alliance has developed training templates that are available on its website at www.im.org/interview. This resource can be customized to individual programs and qualify as an activity for faculty development.
      Before interview-related events, programs should provide a succinct statement to applicants about their expectations for appropriate communication and include a link to or hard copy of the program policy. An example follows:“We strive to adhere to the highest professional standards as encouraged by the National Resident Matching Program and the Alliance for Academic Internal Medicine concerning communication with our applicants during and following your visit with us. All program representatives—faculty, staff, and trainees—who take part in recruitment are trained to know which questions are appropriate to minimize undue stress and coercion on applicants. We believe that every applicant is entitled to a professional, courteous experience. A copy of our program statement is available on our website. Applicants are highly encouraged to approach or email any member of the leadership team with questions or concerns. We look forward to showing you all the benefits of training here.”

      Discussion

      The AAIM guidelines represent reasonable and achievable standards that can avoid undue applicant stress while retaining program flexibility, where needed. It encourages a formal, structured approach to applicant engagement that upholds an applicant’s right to privacy and a professional experience. Although most inappropriate communication is inadvertent and without malice, it adds significant and unnecessary stress to applicants during a difficult transition period. Few faculty or staff have received formal training on interview or post-interview communication etiquette. These guidelines may, therefore, have the added benefit of clarifying responsibilities and reducing faculty anxiety associated with interviewing. Most interviewers want to do what is appropriate and will change conduct accordingly; however, the program must provide the necessary incentives and penalties for this change to occur. Established guidelines and annual training assist both novice and seasoned interviewers in understanding the types of questions they can ask. We expect that programs will widely adopt these 3 recommendations within 2 years and that reports of inappropriate communication will decline significantly.
      Several limitations may attenuate the effectiveness of these guidelines. Programs that have adopted the APDIM guidelines may perceive these new guidelines as regressive because the older guidelines took a stronger stance on post-interview communication. A program’s shift from uniform communication to allowing individual post-interview communication may increase opportunities in which inappropriate communication can occur. Programs retain the ability to set stricter standards than the guidelines. The voluntary nature of the AAIM guidelines is a limitation that will influence its adoption. Increased resource utilization, particularly during the initial implementation phase, is expected. Although AAIM has developed training materials to reduce this burden, some programs have insufficient resources to lead local training and enforcement. Further study will be required to assess acceptability and adoption patterns across widely disparate programs.

      Conclusion

      Appropriate communication with applicants requires education and training for those involved with IM residency and fellowship recruitment. Studies show frequent inappropriate communication, which leads to undue stress and confusion for applicants. The AAIM guidelines set forth reasonable and achievable expectations for program training and conduct. AAIM expects significant decline of inappropriate communication because of wide adherence to its guidelines.

      Acknowledgments

      The authors thank the Alliance leadership for their review and endorsement of this document and its concepts as an AAIM statement. We also thank the AAIM GME Interview and Post-Interview Work Group for its thoughtful discussion and review.

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