The EM Interview Season: Pandemic Edition

As the interview season approaches, both applicants and programs face a new reality—the virtual interview. Thankfully, these should be more meaningful than the solo-recorded Standard Video Interview that fell out of favor last year, but the prospect of the virtual interview season still raises questions for all parties involved. What changes in an interview season where there are no away rotations? Will COVID impact applicants’ decisions on where to apply? Can the virtual interview season deliver both a formal and informal atmosphere, as the old interview season often did? How will programs and applicants alike determine good fit?

In keeping with the times, I virtually called up two fourth year medical students and an EM program director to discuss their thoughts and fears of the upcoming EM application season. Alice and Dan (whose names have been changed) are both medical students applying to emergency medicine residency this year, and Dr. Harsh Sule is the program director at Rutgers New Jersey Medical School.

Away Rotations

Because of COVID this year, there are no in-person away rotations and only a few virtual away rotations. In the past, medical students have used away rotations to learn more about different styles of emergency practice (rural vs urban vs county, etc.) or to audition at a favorite institution, while programs have provided away rotations in order to display their proams and attract new talent. Moreover, not every school has home EM programs. What are your thoughts on the lack of away rotations?

Alice: One really important thing for me in doing aways was trying to pick places that were different. EM has such a variety of styles. Without aways, you don’t get the exposure of what EM might look like in different settings. I like my home program a lot, but I also don’t know what else is out there.

Dan: Aways were one of the aspects of medical school I was really looking forward to—experiencing different points of view, different hospitals, different attending cultures, different patient populations. Having away rotations was going to be something I would have excelled in, and could have used as a focal point in my interviews. Not being able to succeed and shine on an away rotation is a disadvantage for those who didn’t do well on tests or struggled in preclinical years—people who may not look great on paper but have a lot to offer. One way of dealing with that disadvantage is attending the virtual PD sessions and just trying to get noticed, but it’s not easy.

Dr. Sule: The impact of not being able to do away rotations varies from program to program. Some programs are more dependent on their away rotators because they may usually take a large number of their away rotators. They’re now missing out on that opportunity to audition those students. For other programs that have fewer rotators the impact will be less. The real challenge is going to be for students who traditionally use away rotations to explore new programs, especially in terms of style and culture, length of training, patient population, etc. Additionally, this year most students are only going to have one SLOE from their home institution, so if they don’t have a good month for whatever reason, it will be challenging to overcome that.  There’s also a burden on the SLOE-writer to be more objective and reduce perceived home institution-bias—and programs in turn will have to decide how much to weigh and trust any SLOE.

Applying to Programs

As in every application cycle, it’s important for interviewees to remember good etiquette and not hoard interviews that they will likely cancel. If they do cancel, they should remember to give programs at least a one-week notice so that programs can reach out to the next candidates and fill the interview spots. It is also preferable for programs to not send out more invitations than they have interview spots.

With the cost of interviews greatly reduced in this new virtual format—no plane tickets, hotels, or rideshare expenses—there is some worry that applicants may over-apply, making the task of sorting through applications harder for programs as they face higher numbers and increasing the pressure on applicants to stay competitive.

Alice: I think programs have their strategies for narrowing the candidate pool and that won’t change much with the pandemic. My personal strategy of how many programs to apply to? I don’t really know. Every place I apply to, I want to be comfortable actually going there for residency. I don’t want to compromise my criteria for what I’m looking for in a program, so I won’t be applying to more programs just because it’s cheaper and more convenient this year.

Dan: What I hear is most important is to make sure you find the places that you’ll be happiest in, whatever that is for you. I’ll take as many interviews as I can, which in COVID may be more because logistics are easier, but I’m only going to apply to the programs I’m genuinely interested in. 

Dr. Sule: Programs are definitely talking a lot about this likely increase in the number of applications. My view is that a lot will depend on how many interview slots and how much variation in timing programs offer. Though they may have slightly more time without travel considerations, students still have a limited amount of time. From the program side of things, we have to be honest and introspective to figure out what our sweet spot is. As long as we don’t go too far outside that historical sweet-spot and don’t overreach, most programs should be able to limit the number of extra interviews – but it will take an extra effort.

Geographic considerations are another factor that has been impacted by COVID for applicants. Although some applicants may view the lack of travel costs as an incentive and opportunity to apply to more distant locations, others have realized during the stress and social isolation of the pandemic the importance of a close support network and have narrowed their focus to programs closer to family and friends. 

Alice: Initially I was very open to applying all across the country, but because of COVID I started worrying a bit more about being away from family. The prospect of not seeing my family for months on months became more of a concern for me, and I did reconsider applying to far away programs. For people interviewing at programs far from home, I think COVID restrictions on aways and in-person interviewing will make it harder to prove that they do want to move to a certain region. 

Dan: I thought before COVID that I wouldn’t go far for residency because I want to stay near family, but with the flexibility of virtual interviewing, I’m more open to exploring programs that are further away. Because why not? I might find that I like a place that wouldn’t have been on my radar before.

Dr. Sule: Geography will be a more challenging factor than in past years. I think the absence of visiting students that are able to demonstrate their commitment to an area outside their home region will compel some programs to look more closely at geographic ties and other factors that students highlight in their personal statements to assess a candidate’s interest in their program. 

The Virtual Interview

Although most people are now experienced users of Zoom and similar video platforms, moving the entire interview season virtual is no mean feat. Technical snafus aside, the virtual interview this year has to replace a campus visit that usually includes a pre-interview dinner, a tour of the hospital, in-person interviews, and often a sampling of resident didactics. The virtual format risks increased formality, making it harder for programs to get to know the applicants and for applicants to get to know the people of the programs. Judging if a program and an applicant are a good fit for each other will take extra effort and creative innovation of revamping the traditional interview day to its new virtual space. Moreover, body language, eye contact, and facial expression are all key to our interactions with one another, but they are sometimes difficult to decipher on video.

While my biggest fears about a virtual interview would include not appropriately muting my microphone, getting up while wearing sweatpants with my business professional top, or my cat running across my keyboard, my interviewees had more thoughtful answers.

Alice: My biggest fear for the virtual interview is that it becomes immediately formal. The virtual format innately adds formality that’s hard to take away. It makes it difficult to judge programs. And vice versa—the programs can’t really see who you are and how you fit into a program. You don’t get the same kind of experience virtually.

Dan: In a virtual interview, at least you have the home advantage. You don’t have to worry about where to park your car or get stressed about finding the right room—you’re in the familiar environment of your own home. Your anxiety might be a little less. The problem with virtual interviews is, similar to texting, how people come off is more easily misinterpreted. Virtually, it’s also harder to gauge if your interviewer is engaged and responding to what you’re saying because you’re missing that body language. For all you know, they could be reading an email.

Dr. Sule: I’m guardedly optimistic about the virtual interview. Yes, there’s something to be said for shaking a person’s hand and sitting down in-person, but from a program standpoint, we can get a lot of what we need from a virtual interview. For the candidates, on the other hand the challenges will be greater since it’s not the interview but the lack of mingling with residents and the hospital tour that cannot be recreated in the same way virtually. That’s how students often figure out which programs they really connect with. No matter how many virtual breakout rooms you setup, you lose the spontaneity of in-person interactions with current residents, and students will have a more difficult time judging the program’s atmosphere and culture.

The Match

When the interview season is done, then what? How will post-interview communication or rank lists be affected by the pandemic? Since they are unable to visit programs and cities, applicants may have more questions this interview season and may make more requests to speak with current residents around the time that they are trying to put together their rank lists. Programs should make an extra effort to give applicants an opportunity to chat with residents about questions or concerns that they might have. Most residents are invested in who their future colleagues will be and are eager to help with the interview season. When making their rank lists, both programs and applicants have to decide on what the best fits are with less information than years prior, but that stress can be eased by providing good resources, and current residents are every program’s best resource. 

Alice: Again, it’ll be harder this year to figure out which programs are the best fits, especially since it’s hard to get a sense of a place and a people virtually. I’m very openminded going into the application season, but I think I have less of a chance of discovering hidden gem programs virtually. It would definitely be nice to have current residents from programs available to talk to before rank lists are due.

Dan: Finding the right fit will be harder, so making a good list will be too. It’s frustrating that we won’t be able to get the feel of a program by being there, see the lay of the land and the residents in their element, and explore what the city has to offer. PDs this year are probably going to be overwhelmed with pre- and post-interview communication. For deciding what programs are my best fit, I think a lot is going to rely on networking with alumni, friends, and residents, trying to get primary source information.

Dr. Sule: There will absolutely be an uptick in pre- and post-communication this interview season. We have already seen this in the pre-interview period. Similarly, I think there will be a spectrum of approaches in the post-interview period—some programs will do what they did before, and others will have Q&A panels and focused outreach sessions. I worry about it because the rules from ERAS and NRMP are very clear on what can and can’t be said, and when you open up post-interview communication to more program personnel including residents interacting with candidates there is a greater potential for inappropriate commitments being made and miscommunication.

Conclusion

So what will the 2020 pandemic-style interview season look like? Virtual and with its own challenges, to be sure, but all three of my interviewees reminded me that it’s also a time of anticipation and exhilaration—a time of leaning fully into your future and embracing it. I’ll end with my favorite quotes from the two applicants on their feelings for applying to residency. “It’s going to be a new chapter in my life,” Alice says. “You’re going to get a good experience and training at any EM program. Really, I’m more excited than anxious.” And Dan agrees. “At the end of the day, we keep going. People are going to be okay. It’s not the end of the path.”

By Sophia Gorgens, MD, Resident Emergency Physician, Northwell NS/LIJ)

edited by Shannon Moffett, MD@BrickCityEM in conjunction with CORD ASC-EM (advising students committee in emergency medicine)

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