In a normal year, the residency-selection process is anxiety-provoking. Adding a global pandemic to the mix—resulting in key aspects of the process being altered—may deepen those anxieties.
A recent webinar in the AMA Innovations in Medical Education Webinar Series—“Residency Application Process: Current Challenges and Potential Solutions”—examines some of the typical challenges of residency selection and how they might be addressed during the atypical 2021 application cycle and beyond. A recording of the webinar is available in the resources area of the Accelerating Change in Medical Education Community (registration required).
Challenges for applicants
Even in normal times, the process of finding a residency program can be taxing on students. As highlighted by Kathleen Kashima, PhD—senior associate dean of students at University of Illinois College of Medicine—this year’s cycle could add greater uncertainty to the process of distinguishing among residency applicants. Some of the milestones that are traditionally part of the process, such as away rotations, also have fallen by the wayside due to travel restrictions.
According to Kashima, areas disrupted by the pandemic include:
- Clerkships: Length, grading and difficulty in assigning quartiles.
- Letters of recommendation: With medical students having less face time, it may be more difficult to find letter writers.
- In-person interview: Moving interviews to a virtual setting because of the pandemic will make it harder for medical students to get a sense of a program’s culture.
Because of these and other uncertainties, medical students’ application behaviors may change this year.
“We are encouraging student applicants to apply to programs that they see as a good fit and not flood the zone with applications,” Kashima said. Find out how residency programs will view applications in 2021.
“Competitive specialties and prestige programs may get more applications. More students than usual may choose to do joint degrees and research programs, which will increase the number of applications next year. There are some groups of students who have more angst and may apply to more programs.”
Despite those potential realities for the upcoming cycle, Kashima cited reasons for optimism—including the quick responses stakeholders made to accommodate this year’s Match—on a community movement toward a healthier Match culture.
Revisiting the standard video interview
Citing a lack of interest among applicants and program directors, the Association of American Medical Colleges (AAMC) announced that a video interview program it had been piloting for emergency medicine residency programs would not continue past the 2020 application cycle. Still, the experience some faculty programs had with the standard video interview (SVI) program could inform the upcoming cycle of virtual interviews, said Fiona Gallahue, MD.
Dr. Gallahue cited research on the now defunct SVI program offers some insight on student preparation habits that is likely applicable to the upcoming virtual interview cycle. Data cited from a 2018 study shows that:
- About 6% of applicants did not prepare in advance of their video interview; around 3% reported preparing seven hours or more.
- More than half of applicants accessed at least one practice question made available on the platform on which the interview was to take place, and two-thirds reported reviewing practice materials provided by the AAMC.
- About one quarter practiced answering hypothetical questions through another video platform—SVI interviews took place on a platform programs are unlikely to use for virtual residency interviews.
“There are some take-home points from the SVI,” said Dr. Gallahue, director of the emergency medicine residency program at the University of Washington. “One is that it’s possible that unconscious bias can be limited and maybe even eliminated in an interview setting if enough time and resources will be applied. At least 10% of our applicants will have technical difficulties, so it’s best to offer a plan B and maybe even a plan C.
“A majority of our applicants will be doing the interviews in their homes, so that they can be in a comfortable environment,” she added. “Certainly, it makes sense to encourage that. Students will likely prepare for these interviews better if they are given materials in advance, coaching and have expectations set. I really don’t think we want anyone preparing more than seven hours.”
Learn why the AAMC halted the standardized video interview.
Making a more efficient process
In 2010, 18% of student applicants from U.S. MD-granting medical schools matched with a school they ranked fourth or lower on their list. In 2020, that number was at 24%. Maya M. Hammoud, MD—chair for education at University of Michigan Medical School—offered that data as evidence that the Match is becoming less efficient with the increasing number of applications.
To help with efficiency, she offered three proposed approaches:
- A potential cap on number of applications per applicant.
- A preference-signaling system that allows applicants to express interest in a small number of programs.
- An early acceptance program that would allow students and programs an opportunity to match in advance of the typical March date.
The third measure is one which Dr. Hammoud is pursuing via a grant from the AMA Reimaging Residency initiative grant. The project—“Right Resident, Right Program, Ready Day One”—aims to improve the continuum of education between medical school and residency. The project strives to optimize the alignment and compatibility between interested applicants and potential residency programs.
“We all want the same thing,” Dr. Hammoud said. “We all want the cycle to be a lot better and we are all working to make it the best it can be. But, clearly, the current status is not acceptable. We all can see it deteriorating year after year and we can’t just stand by and watch.”
The AMA has curated a selection of resources to assist residents, medical students and faculty during the COVID-19 pandemic to help manage the shifting timelines, cancellations and adjustments to testing, rotations and other events at this time.