Happy New Year?

The two weeks spanning the winter holidays and leading into the new year are a glorious time.  Not only because of the holiday festivities (family, friends, gift-giving, gorging on fudge and pecan brittle, popping champagne) but also because we finally get a break from the interview season.  The last few months of frenetic activity all of a sudden goes on pause and there is this blessed protected time where we are not “supposed to be” doing anything specific.  The world of students and programs holds their collective breath, regroups, and prepares to head into the final push to the end.

We likely do not speak only for ourselves when we say that if we never hear the phrase “unprecedented interview season” again it will be far too soon.  Students and programs alike are sick and tired of the uncertainty, the predictions, the panic, and the intermittent chaos this interview season brought.  But how much of that is all in our heads?  How much of what we began predicting about this interview season back in May has come to pass?  How many of the “surprises” from this season have truly been surprising? 

We take this moment in time, this golden pause, to look back at some of the questions we had in order to look forward to see what answers we might gather over the next weeks and months.

“What will make a competitive application if we have no away rotations?”

One of the cardinal moves of this year was the Consensus Statement, joint-published by every major EM national organization, supporting the Coalition for Physician Accountability’s recommendations that students complete only a home EM rotation1.  This action displayed the unity, teamwork and focus on the greater good we are proud of in EM.  But it also raised some questions: How do we now evaluate how a student truly performs clinically?  After all, isn’t your home institution “supposed” to like you?  Everyone knows it’s only when a student goes to a different program that we get an unbiased view of them–or is it?  These thoughts led to more: Did orphan programs have an easier or harder time getting a “home” rotation in 2020? How do we police ourselves to ensure an accurate and high quality eSLOE from the home program?  What about these new OSLOEs from non-EM specialties, how useful have those really been?  Students wondered if there would be more emphasis in application review on research and community service, and worried that their USMLE scores now be the defining point of their med school careers.  Theoretically, all students nation-wide were now in the same boat.  But did we do a good enough job policing ourselves to ensure fair and equal opportunities for all applicants, and fair and equal treatment of all applications?

“Virtual interviews…. Yeah, how do we do that?”

Zoom fatigue seems real.  Like, really really real.  Yet, appropriately, one of the pushes made across specialties for this application cycle was for across-the-board virtual-only residency interviews.  For many of us on the advising side, this provoked horrible flashbacks to advising for the SVI (remember that??).  How to position your computer, what’s in your background, are you wearing anything too distracting, make sure you’re on mute, make sure you’re NOT on mute, ugh….but also—is everyone getting access to—and able to comply with–the same guidance?  

And on the program side, how do you convince applicants you’re the greatest thing since sliced bread if they can’t actually be in the same room as you?  It’s really hard to put together a good HIPAA-compliant virtual tour of your department and campus, or to have friendly faculty banter or side conversations when everyone is sitting at home staring at a computer screen.  Let’s not even start on the struggles of trying to simulate the traditional resident dinner.  We predicted early that going all-virtual could be a lose-lose: applicants might have a hard time demonstrating their “fit” with a program, and programs would have a hard time showing their true colors to attract future residents.  But did any of these fears pan out?  Do we really have to be in the same room with a person in order to know who they are?  Do we need to be in person, or has this year potentially changed the residency interview process forever?  It’s certainly got its upsides: significantly less expensive for both students and programs, and the ability to change interview schedules at a moment’s notice.  But what about the downsides?  Tech difficulties, awkward angles, a pet—or child—that makes an inopportune appearance…  We’ll see how the computer chip crumbles.

“How many programs should I apply to, how many interviews do I go on, won’t the top 10% of students hoard all the interviews, what if we are interviewing all the same candidates…?”

We’ve lumped this last group of questions together because these are the ones that weigh heaviest on our minds.  Early in the process of this application year, many predicted that the interview creep (the trend for students to be applying to and interviewing at more programs than is necessary) would be a major issue.  And the initial wave of applications seemed to support that fear, with most programs (even outside of EM) anecdotally reporting anywhere from a 10 to 40% increase in the number of applications received.  

Our fears were reinforced as conversations between programs and clerkship directors seemed to point to a greater than normal number of middle-third applicants without a “safe” number of interviews.  A recent publication from the AAMC encouraging programs and applications to maintain the honor of the interview process to ensure equal opportunities for all seemed to acknowledge the problem.2  However, a recent publication by Thalamus would seem to support the opposite.3  According to their preliminary data, they report no major difference in interview patterns compared to any other year.  Their findings included no major overlap in programs students at which students interviewed (discrediting the “top 10% hoarding” theory).  They also noted that the number of interview offers given to the average student seems to be the same as in prior years.  

Now, granted, these data come with the caveat that this analysis is limited to the pool of programs using Thalamus, and is not EM-specific, but it is interesting enough for us to ask ourselves if we are really seeing an increase in problems this interview season, or are we just noticing our same problems a little more?  With weeks still left in the interview season, there is still plenty of time to see how things will change. And plenty to mull as we put away the holiday decorations, finish up our last virtual interviews, and gather ourselves for next year’s application season. 

  1. The Coalition for Physician Accountability’s Work Group on Medical Students in the Class of 2021 Moving Across Institutions for Post Graduate Training. (2020). 
  2. Final Report and Recommendations for Medical Education Institutions of LCME-Accredited, U.S. Osteopathic, and Non-U.S. Medical School Applicants. Retrieved from https://www.aamc.org/system/files/202005/covid19_Final_Recommendations_05112020.pdf
  3. https://thalamusgme.com/2020-residency-recruitment-crisis/

Molly Estes, MD FACEP FAAEM–Loma Linda University Medical Center, Department of Emergency Medicine–Assistant Professor and Cerkship Director @molly_estes

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

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