Virtual Interviews in Postgraduate Medical Education Recruitment: Is There a Future Post-Pandemic?

Prior to the COVID-19 pandemic, postgraduate medical education trainee selection for North American residency and fellowship programs relied on in-person interviews. This process could involve candidates traveling and staying overnight near the program; attendance at informal social receptions with faculty, trainees, and other applicants; experiencing the program's educational culture; and exploring the area. Program faculty were able to meet with candidates in-person, in formal as well as informal settings.Social distancing and travel restrictions during the pandemic resulted in a pivotal transition to virtual interviews, a relatively novel concept in postgraduate recruitment. Potential benefits from this change include decreased candidate and program costs, improved time efficiency, and reduced environmental burden. This article aims to explore what has been learned about virtual interviews to date and to argue for continued incorporation of this format.Multiple studies have demonstrated that virtual interviews are less costly and time-consuming for both applicants and programs.1 Many published surveys, well-summarized by Tseng,2 provide estimates of the personal financial burden for residency or fellowship interview costs prior to the virtual interview process. A single in-person interview for senior medical students participating in the US Main Residency Match commonly costs between $250 and $499.3 The average total individual interview costs for candidates applying to surgical specialties or subspecialties ranges from $4,000 to $6,000, predominantly resulting from travel and accommodation expenses.2 A majority (72%) of applicants have reported borrowing loans to finance application costs, and these costs have risen over the years.3-5 Furthermore, 41% of applicants have expressed turning down 3 interviews (on average) for financial reasons.3 One study of urology residency applicants comparing in-person interviews and electives to a virtualized process demonstrated average cost savings of $173 per interview, for each applicant, just from transportation costs.6 The transportation costs amounted to an average total of $2,198 for each applicant, with over $1 million saved for the virtual interview applicant pool.6 Studies have shown that virtual interviews save on average $3,000 to $8,000 per applicant, with over 90% of applicants reporting having spent less money in the virtual interview process than the in-person process.4,5,7-13 This is a particularly important consideration, as studies have also demonstrated that costs associated with in-person interviews can deter applicants from applying to multiple programs or accepting multiple interview offers.1,6,14 Similarly, in-person interviews also involve significant program costs. Program directors have reported an average additional $13,300 for social expenses over a single interview season.15 Surveys of residency program directors have demonstrated that the recent virtual interview processes have resulted in decreased program costs.7,16The interview process is not only expensive, but it also can be quite time-consuming.2,17,18 Studies have demonstrated that an average of 8 to 12 days are missed during a residency program for fellowship interviews, with a majority of residents (61%) using their vacation time.2 Virtual interviews shorten the interview period by removing travel time, which may minimize disruptions to training programs, patient care, and clinical productivity of candidates and faculty while they are engaged in the interview experience.19 A survey of applicants from the 2020 virtual interviews compared to applicants from the 2019 in-person interviews demonstrated that a greater proportion of applicants used fewer vacation days.1 One-third of applicants saved at least 2 weeks with the virtual process compared to in-person interviews.10 Applicants also expressed that virtual interviews had positive benefits to personal and family well-being due to the increased schedule flexibility and saved costs.20The cost and time savings along with scheduling flexibility that virtual interviews offer may contribute to a greater number of program applications by candidates and a greater number of interview invitations from programs. Surveys have shown that 40% to 76% of programs across specialties have reported increasing the number of invitations sent out since the virtual interview process.1,7,11,20,21 Similarly, many candidates also applied to more programs or were less likely to decline interview offers in the year of virtual interviews, compared to prior years, maximizing their chances of matching.7,22,23 There were over 10% more applications received by programs in the year of virtual residency interviews,24 although exact effects on trainee match rates are not yet clear.Participating in interviews is essential for the evaluation and matching process for both candidates and program faculty. Additionally, given that there are often more applicants than available positions,25,26 and a risk of going unmatched, there is strong incentive for applicants to participate in as many interviews as possible. However, the financial costs, particularly associated with airfare and lodging, may introduce socioeconomic status and ability to finance an interview as factors in the selection process, rather than the individual candidate's suitability for the program.Using virtual interviews is one strategy to eliminate most personal interview travel and accommodations costs, and thus financial burdens, as well as reduce potential bias related to geographic location of candidates.27,28 Some studies show that the majority of applicants and program directors perceive that virtual interviews improve applicant equity.20 While some studies demonstrate that virtual interviews can introduce more bias for underrepresented groups in medicine, and may make gauging program inclusivity difficult for applicants,28,29 the impact of the transition to virtual interviews on diversity, equity, and inclusivity is not yet established. Multiple strategies have been proposed to mitigate bias in the virtual interview experience (Box).In-person interviews have clear environmental costs, resulting from flight and car travel to multiple sites. Using an estimated carbon calculator of roundtrip car and flight travel, one study demonstrated that, comparing in-person to virtual interviews for urology residency applicants, virtual interviews reduced emissions by 3011 tonnes of CO2 equivalent (tCO2e).6 This reduction is equivalent to emissions generated over a year from 182 typical Americans and would require 3689 acres of forests to generate these emissions in a year.34 For Canadian residents in 2020, in-person interviews led to 4239 tCO2e emitted (with approximately 1.44 tCO2e/applicant),35 compared to virtual interviews, which produced only 2.9 tCO2e (0.99 kgCO2e/applicant), thus reducing emissions by 98.4% to 99.9%.35 Limiting travel during the interview process is a tangible way to reduce our postgraduate program carbon footprint.A primary challenge to adopting all-virtual recruitment interviews is the loss of the interpersonal experience, which is an important determinant in candidate and program rankings.36 A main interview goal is to find a good fit between the individual and the work environment, which ultimately correlates to overall performance, job satisfaction, and attrition.37 Not all applicants and program directors felt that virtual interviews alone were sufficient in providing accurate representation of a candidate or the program culture.1,38,39 Some program directors believed that virtual interviews decreased their ability to assess a candidate's fit, particularly regarding interpersonal communication skills, clinical skills, and genuine interest in the program.7,16,24 Some applicants expressed that having informal interactions with other residents and faculty, as well as opportunities for program tours, were important components in their assessments of the program's culture and structure.40 For applicants, the incorporation of virtual interviews sometimes led to the loss of ability to assess programs and to poor quality of interactions with others, affecting confidence in their rank lists.10,12,22,30,31 Despite these reports, other studies demonstrated that implementation of virtual interviews effectively met overall program and applicant goals without significant differences in interview outcomes, including candidate and program assessment, ranking, and matching.1,11,20,21,33,41,42Despite their many limitations, these studies suggest that virtual interviews were generally well-received, and both programs and applicants appear to favor a hybrid interview model for the future.1,9,16,21,22 However, no studies have yet compared hybrid models to in-person-only or virtual-only models. This could be one area for future exploration.We believe there are substantial benefits to continuing virtual postgraduate medical education interviews following the COVID-19 pandemic. These benefits include reduced financial and environmental costs, greater scheduling flexibility, and more time saved for personal and clinical duties. The loss of the interpersonal experience may be a challenge in candidate recruitment, though the overall results in candidate assessment and matching do not appear to be affected. There is also strong interest in incorporating virtual interviews as a hybrid model, with both in-person and virtual visits available to applicants. Although strategies to improve the virtual interview experience and mitigate potential bias around who can afford to visit in-person have been proposed, additional study of these processes is critical.

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