How the pandemic has changed the residency application process

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In today’s COVID-19 update, AMA Chief Experience Officer Todd Unger talks to health experts about changes in the residency application process due to COVID-19, including its impact on in person interviews and the potential increases in program applications.

Learn more at the AMA COVID-19 resource center.

Speakers

• John Andrews, MD, vice president, GME Innovations, AMA
• Sarah Brotherton, PhD, director, Data Acquisition Services, AMA
• Kyle Paredes, MD, assistant dean, Student Affairs of UC Irvine Health

Unger: Hello, this is the American Medical Association's COVID-19 Update. Today we're discussing changes in the residency application process due to COVID-19 I'm joined today by Dr. John Andrews, the AMA's vice president of graduate medical education innovations in Chicago, Dr. Sarah Brotherton, the AMA's director of data acquisition services in Chicago, and Dr. Kyle Paredes, assistant Dean for student affairs at UC Irvine Health in Irvine, California. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Andrews, let's begin with you. In the spring, how are medical students who are now applying for residency affected when the nation essentially shut down in March?

Dr. Andrews: Yeah, thanks Todd. Well, when COVID landed, many medical schools made the responsible decision to remove medical students from rotations where they were in direct contact with patients who might have COVID, out of an abundance of caution. And one of the effects of that was that students were no longer able to fulfill rotations at institutions where they might be interested in training as a resident, the so-called audition rotations, or away electives, were often canceled. They also had to forgo specialty experiences at their own institution that helped them to clarify their interest in a given specialty or that might lead to letters of support for the residency application. So I think there was a lot of anxiety about the students' ability to both confirm their own interest in a specialty in which they were applying and also to demonstrate their skills to a program that might be interested in hiring them as a resident.

Unger: Dr. Brotherton?

Dr. Brotherton: Yes and because of these factors, the Electronic Residency Application Service, or ERAS, which has traditionally set the date that program directors can start downloading applications from students at mid-September altered the date, moved it back to October 21st. This will help students continue to refine their list of programs to apply to, which is especially important as students didn't have that opportunity for away rotations, like Dr. Andrews mentioned, so they may need more time to research programs. In addition, getting letters of recommendations may be more challenging as well as those opportunities for the away rotations and a chance for those students to shine for faculty have been reduced. That extra time could be used for working on their personal statements to make sure that they can stand out as an applicant that will fit with a particular program or specialty.

Dr. Paredes: Yeah, I think definitely the extra time has been really beneficial for the students as we've had these test dates change and dropping away rotations, it's increased anxiety a lot. The students have had to kind of rally and figure out how to just kind of make a game plan on the fly. And so we've allowed our students to start doing multiple rotations in the same field here at their home institution, at our affiliates so they can kind of try to get a little bit more of that same breadth that they would get by doing away rotations, that we've had to kind of just roll with it with the test failure.

So step two and CS and CK, we've had to change our school's way that we've approached it. Usually they have to have that done by December. We've kind of extended that, give them a little bit of leeway to make sure that they don't have the added stress on top of the application stress and trying to figure out what they're going to do for residency. But the extra time has been, I think, really important for these students to get that little more space to explore, to get some more involvement in the departments here at our home institutions that can kind of really kind of define their plans, and then also get strong letters of support from our own faculty.

Unger: Dr. Andrews, how's the interview portion of the application process been affected by COVID-19 and what impact have those changes had on students and programs?

Dr. Andrews: I think the impact is remains to be seen. An important component of the residency application process has been visiting a residency program to interview in person for a position and for obvious reasons, there's strong suggestion that residency programs conducted interviews virtually rather than requiring applicants to travel. This limits the ability of the applicant to visit a program and to learn more about what the culture of the program might be, what it might be like to live in a given city. It also prevents the program from meeting someone in person and relying instead on the sort of interaction that we're having here in this meeting. And I think that raises some questions about the standards for virtual interview, the access to the technology to conduct the interviews, whether there might be some concerns about adequate access for people in areas where internet capabilities might be limited there. It raises a host of questions and, again, a host of further anxieties, I think, for the applicants.

Unger: I'm curious about how that will affect the number of applications. Dr. Paredes, do you have any perspective on that?

Dr. Paredes: Yeah, I think talking to students and talking to our program directors here, that the general sense is that people are going to be applying to more programs. I think you add that level of uncertainty, you add this kind of unfamiliarity on both sides. The program directors are just as anxious about these virtual interviews as the students are, but the concern is that this is going to just skyrocket the number of programs that people are applying to because they're trying to put their best foot forward and give themselves the best opportunity with their limited experience. They haven't been able to do aways in other cities and other places to show this real commitment to go to New York or to go to Chicago or to go to Southern California, and so they feel like they have to apply to more places to get themselves that same benefit.

Unger: How do you think that is going to affect the way that applications are viewed when so many more are coming in?

Dr. Paredes: Yeah, there's been a big push recently for more holistic review of applications, so trying to look beyond just scores and look at the applicants, their background, what they bring to the table, unique things that they do, kind of more diversity and equity and giving a deeper feel for each of the applications. But as you get more and more applicants, it limits the ability to do so. And then, now the programs are having a shorter timeframe given the extra time we have given the students is given a little bit of a crunch. And so I think the concern is that those metrics are going to be used, I think, more so this year than in previous years to try to narrow these giant pools of applicants that the programs are each going to be seeing.

Unger: Dr. Brotherton, how are you seeing that interview portion of the application process changing?

Dr. Brotherton: Well, the national resident matching program has also adjusted their schedule and moved things out so that there can be some more time for the virtual interview. Usually the students start certifying a rank order list of preferred programs mid-January, which is actually before the deadline for programs to change their quota positions or even withdraw from the match. This year, the applicants can start certifying the rank order list February 1st, so a whole half month later. And that is actually the day after programs fix their quota or even withdraw from the match, so that really makes a lot of sense.

Also, the deadline for both programs and applicants to certify the rank order list has been moved back by several days to March 3rd, which will also give all participants more time to interview and make ranking decisions. It will also allow for another USMLE score release before March 3rd. And finally, the interim P has added a fourth round to the Supplemental Offer and Acceptance Program, or SOAP, which occurs after the main match for applicants who didn't match and for programs that didn't fill. And this will provide another opportunity for students to match into a program successfully.

Unger: Dr. Brotherton, what is the AMA doing to help students and programs navigate some of these changes and challenges?

Dr. Brotherton: Well, the AMA has FREIDA, which is AMA's directory of residency and fellowship programs all accredited by the ACGME. FREIDA is very popular resource for students and residents researching programs. Year to date, FREIDA has had over 340,000 users viewing 14 million pages of content. So with so many users, it's important that we continue to add more information and engaging features to FREIDA to assist users and AMA members in the research.

To that end, this year we added the ability for users to save their searches. FREIDA has over 35 different filters to help refine a list of programs. Now users don't have to remember just which filters they use to get a list of pediatric programs in the Midwest with a subsidized childcare, for example. We also added a residency application calculator that AMA members can use to estimate their costs for applying to programs. It has the option of no travel expenses, which sadly is going to be in play this year. However, it is expected that students are going to be applying to more programs than before, and they're going to want to be able to keep track of those application costs.

We also fully mobile optimized the websites, and a lot of our users use tablets and phones so that was important. We also added the ability for programs to completely edit their program description on FREIDA. Before they get edit a small part, now they can edit everything. So this will be very helpful for programs to more fully described the environment of the program and keep it up-to-date in order to attract the right applicant.

And then finally, we just added the ability for programs to include on FREIDA a video tour of their programs. Not only can programs provide a link to a video that they may have already created, but we've also prepared a guide to help programs create their own video, with tips on the technical side of filming, suggestions on succinct ways of describing their programs, how they might want to add music, what they might want the residents in the video to talk about, and finally tips on how to upload the video to YouTube. And we hope that all programs will be able to take advantage of this new feature so that applicants can get a flavor of the program since there won't be any in person interviews this year.

Unger: Dr. Paredes, how are programs coming up with innovative solutions to make the residency application process better, both in reaction to COVID, as well as to address issues that existed even before the pandemic?

Dr. Paredes: Yeah, I think it's really putting residency programs kind of on the spot to implement changes and new ways to represent themselves. I think using resources like FREIDA, using these online videos and tours to help students kind of get a feel for what the program looks like, what the environment looks like, getting tours of the hospitals so at least the surroundings look familiar, I think there's been a lot of push and kind of what can we do to help ourselves shine?

Is it useful to do these little online mixers with the residents so they kind of have a little bit of a casual feel and they can kind of talk about the nitty gritty, trying to pick the right people to be on the videos, to be able to talk about their experience in residency and trying to display the diversity and the different things that occur in a residency program. And I think it definitely takes a lot of effort and a lot of time, but I've been impressed by the amount of work that each of these program directors have put in to make these holistic interview experiences despite the fact that they can't be in person.

Unger: Dr. Andrews, what are your thoughts?

Dr. Andrews: Well, I think things are definitely different this year. I think you correctly observed that many of the issues that are surfacing and causing anxiety this year have been president or low-level in the past and it's really been highlighted by the pressures of the pandemic. And so both from the standpoint of applicants and programs, I think there's been a call to re-examine the residency application process and try to make communication more transparent so that students are less anxious and don't feel compelled to supply apply to so many programs. And program directors, who aren't compensated for their efforts to review applications, can actually sit down and thoughtfully review a manageable number of applications to select the right residents for their program. And I think everybody thinks that the system could operate better than it does. And I think the pressures of responding to the pandemic are going to lead some of the innovations that would address these problems to be accelerated.

Unger: Well, thank you so much for your efforts there. That is it for today's COVID-19 Update. I want to thank Dr. Andrews, Dr. Brotherton and Dr. Paredes for being here today and sharing their perspectives. We'll be back soon with another COVID-19 update. In the meantime, for resources on COVID-19, visit ama-assn.org/COVID-19. Thanks for joining us and please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.