Interview day serves as a key step in assessing applicant qualifications for medicine residency.
1
,2
During the 2020-21 match season, the traditional in-person interview process was transformed into a virtual one due to the COVID-19 pandemic. Recent guidelines ensure that remote interviewing will be relied upon nearly exclusively among United States medical training programs for the foreseeable future.3
The change has generally been well received – particularly in relation to cost, equity and logistics.
2
, 3
, 4
, 5
, 6
, 7
However, studies which have focused on the ability of programs to evaluate the strength of particular applicant-attributes paint a different picture. In a national survey of residency program directors from a variety of specialties, most were less confident in assessing an applicant's professionalism (60%) and interpersonal skills (61%) using a virtual platform, and (44%) found it challenging to assess an applicant's “fit,” while 74% found it challenging to gauge an applicant's interest in their program.5
Similarly, among internal medicine program directors, most rated virtual interviewing (disadvantageous v advantageous) in relation to assessing an applicant's competency (55% v 2.5%), interpersonal skills/alignment with interview team (66% v 7%) and interest/understanding of the program (67% v 8%).8
In a survey of faculty-interviewers at our training program following the 20-21 season, ratings were significantly higher (≥8 of 10) for their ability to make assessments in-person in nearly all domains. Differences in ratings between in person versus virtual interviewing were most pronounced in relation to soft-skills: communication (86% v 50%), attitude (73% v 59%), humanism (55% v 26%), professionalism (50% v 27%) and interactions with others (41% v 11%). Overall satisfaction with in-person interviewing was also higher (77% v 48%). See Table 1Table 1Faculty Assessment of Virtual compared to In-Person Interviewing
| Survey Item | Format | N | Range | Med (IQR) | Top 3 box, Count (%) | Wilcoxon Signed Rank Test | ||
|---|---|---|---|---|---|---|---|---|
| Z | P | |||||||
| Overall satisfaction | In-Person | 22 | 6-10 | 8 | (7.75-9.3) | 17 (77) | -2.96 | 0.003 |
| Virtual | 27 | 4-10 | 7 | (6-8) | 13 (48) | |||
| Ability to assess or rate the following: | ||||||||
| Clinical competence | In-Person | 22 | 5-10 | 7 | (6.75-8.3) | 10 (45) | -2.59 | 0.01 |
| Virtual | 27 | 2-10 | 7 | (6-8) | 10 (37) | |||
| Intellect | In-Person | 22 | 7-10 | 8 | (7-9) | 15 (68) | -3.07 | 0.002 |
| Virtual | 26 | 5-10 | 8 | (7-8) | 15 (58) | |||
| Humanistic traits | In-Person | 22 | 3-10 | 8 | (7-9) | 12 (55) | -2.85 | 0.004 |
| Virtual | 27 | 3-10 | 7 | (6-8) | 7 (26) | |||
| Communication skills | In-Person | 21 | 7-10 | 9 | (8-9) | 18 (86) | -3.31 | 0.001 |
| Virtual | 26 | 5-10 | 7.5 | (7-8) | 13 (50) | |||
| Accepted norms | In-Person | 21 | 6-10 | 8 | (7-9) | 14 (48) | -3.37 | 0.001 |
| Virtual | 26 | 4-10 | 7 | (6-8) | 10 (38) | |||
| Interactions with others | In-Person | 22 | 3-10 | 7 | (5.8-8) | 9 (41) | -3.74 | <0.001 |
| Virtual | 27 | 1-9 | 3 | (1-7) | 3 (11) | |||
| Relationships with letter writers | In-Person | 21 | 4-10 | 7 | (6.5-8) | 8 (38) | -1.29 | 0.197 |
| Virtual | 26 | 1-10 | 7 | (6.75-8.3) | 10 (39) | |||
| Professionalism | In-Person | 22 | 5-10 | 7.5 | (7-9.3 | 11 (50) | -3.13 | 0.002 |
| Virtual | 26 | 1-10 | 6 | (7-8) | 7 (27) | |||
| Dependability | In-Person | 21 | 2-10 | 7 | (5.5-8) | 7 (33) | -2.40 | 0.016 |
| Virtual | 25 | 1-10 | 6 | (4.5-7.5) | 6 (24) | |||
| Attitude | In-Person | 22 | 7-10 | 8 | (7-9.3) | 16 (73) | -3.38 | 0.001 |
| Virtual | 27 | 4-10 | 8 | (7-8) | 16 (59) | |||
Rating scale: (10 Maximally Satisfied, 1 Minimally Satisfied); “Top 3 box” refers to ratings of 8, 9 or 10 on a 10-point scale; Abbreviations: IQR – interquartile range
In terms of ranking applicants, program directors (PD's) in internal medicine have weighed most heavily interpersonal skills and interactions between applicants, faculty and house staff.
2
Those attributes PD's most closely associated with resident success were professionalism, quality of patient care and clinical competency.9
Importantly, the soft skills found to be particularly valuable are also among the most difficult to remediate when deficient or lacking during residency.- Kim J
- Blaum C
- Ferris R
- et al.
Factors associated with hospital admission and severe outcomes for older patients with COVID-19.
J Am Geriatr Soc. Feb 18 2022; https://doi.org/10.1111/jgs.17718
10
As the interview day plays a particularly prominent role in assessing such soft skills, the movement to conduct all interviews remotely has potential long-term implications for the future physician pool.Despite the numerous and clear benefits of virtual interviewing, the long-term effects of this sea change on graduate training are not well understood.
11
Or as the Alliance for Academic Internal Medicine guidelines acknowledge, some implications of all-virtual interviews warrant further evaluation.3
As information technology assumes a more dominant role in the practice of medicine, from interview day onward, we believe that the words Frances Peabody remain true, “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”
12
A reduced ability of interviewers to identify applicants with this attribute may be the Achilles heel of virtual interviewing.- Peabody FW.
The Care of the Patient.
Journal of the American Medical Association. 1927; 88: 877-882https://doi.org/10.1001/jama.1927.02680380001001
References
- Factors used by program directors to select residents.J Med Educ. Jan 1986; 61: 10-21https://doi.org/10.1097/00001888-198601000-00002
- Program Director Survey.National Resident Matching Program, Washington, DC2020 (Accessed Accessed April 10, 2022)
- Emerging from the Pandemic: AAIM Recommendations for Internal Medicine Residency and Fellowship Interview Standards.Am J Med. Oct 2022; 135: 1267-1272https://doi.org/10.1016/j.amjmed.2022.07.001
- Virtual Residency Interviews: Applicant Perceptions Regarding Virtual Interview Effectiveness, Advantages, and Barriers.J Grad Med Educ. Apr 2022; 14: 224-228https://doi.org/10.4300/JGME-D-21-00675.1
- Evaluation of the Virtual Interview Format for Resident Recruitment as a Result of COVID-19 Restrictions: Residency Program Directors' Perspectives.Acad Med. Sep 1 2022; 97: 1360-1367https://doi.org/10.1097/ACM.0000000000004730
- Virtual Recruitment Is Here to Stay: A Survey of ID Fellowship Program Directors and Matched Applicants Regarding Their 2020 Virtual Recruitment Experiences.Open Forum Infect Dis. Aug 2021; 8: ofab383https://doi.org/10.1093/ofid/ofab383
- Virtual Interviews During Internal Medicine Recruitments: An Unexpected Favorable Outcome of the COVID-19 Pandemic?.Am J Med. Aug 2021; 134: 935-936https://doi.org/10.1016/j.amjmed.2021.03.002
- Applicant and Program Director Survey Findings: Impact of the Virtual Experience on the Transition to Residency Research Brief.National Resident Matching Program, 2021 (Avilable at:) (Accessed 1/15/2023)
- Factors associated with hospital admission and severe outcomes for older patients with COVID-19.J Am Geriatr Soc. Feb 18 2022; https://doi.org/10.1111/jgs.17718
- Emergency medicine directors' perceptions on professionalism: a Council of Emergency Medicine Residency Directors survey.Acad Emerg Med. Oct 2011; 18: S97-103https://doi.org/10.1111/j.1553-2712.2011.01186.x
- Reimagining Residency Selection: Part 2-A Practical Guide to Interviewing in the Post-COVID-19 Era.J Grad Med Educ. Oct 2020; 12: 545-549https://doi.org/10.4300/JGME-D-20-00911.1
- The Care of the Patient.Journal of the American Medical Association. 1927; 88: 877-882https://doi.org/10.1001/jama.1927.02680380001001
Article info
Publication history
Accepted:
February 5,
2023
Received:
February 3,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
No Funding sources
The authors report no financial conflicts
All authors had access to the data and a role in writing the manuscript
Identification
Copyright
© 2023 Published by Elsevier Inc.
