The Pros and Cons of Virtual-Only Residency Interviews

This transcript has been edited for clarity.

I'm trying to imagine what it's like right now for fourth-year medical students applying to residency, and my mind is all over the place. The COVID restrictions make sense, but I still think it's a little ridiculous that you can fly across the country, go to a restaurant, a bar, or a Broadway show, but you can't do an away rotation or have an in-person interview.

Nonetheless, virtual interviews are giving the residency application process a necessary shake-up. We should talk about it because I honestly think post-pandemic virtual interviews will be here to stay, at least in some part.

Quick Flashback

When I was applying for residency, I was a pretty solid candidate. I wasn't a junior AOA, and I didn't have a 260 on my Step 1, but I had good scores. I had letters, research, extracurriculars, and four away rotations, so I felt confident heading into the Match. Those away rotations got me letters of recommendation, helped me network, and they helped me prepare for residency.

But the in-person interviews were clutch for me. I got to make an impression and meet people. I also got to learn about the programs, the vibe, the culture, the diversity — all of it. Now, you take all this away and make it all virtual, and it's a completely different game.

So with that, let's talk about some of the pros and cons when it comes to virtual interviews. And yes, I did my homework and I chatted with several fourth-year medical students about all of this.

Pros and Cons of Virtual Interviews

First, it's hard to stand out, be memorable. We've all been living on Zoom for the past 18 months. We're kind of used to it, but this is a different, complex beast. Applicants are selling themselves to a residency program across a webcam to really tired residents and attendees. That's hard.

I also worry that there's a little bit of bias when you're comparing notes between a virtual candidate you've never met and another virtual candidate who happens to be an internal one who is from that program or medical school.

But here's some hope. Back in 2011, the University of Arizona's ophthalmology department had two options for an interview: a videoconferencing one or a traditional face-to-face one. In the end, they found no statistical difference in their ranking between virtual or in-person interviewees. So that's reassuring. It's only one study, but a lot of the fourth-year medical students I talked to today just feel that they have a loss of control of the virtual process.

Now, I did see an article being shared online about variables applicants can control during remote interviews, but they were things like audio, lighting, dress code, and tech setup. Not everyone can afford a swanky audiovisual setup at their place. So therein lies some disparity. But then again, fourth-year medical students are saving a lot of money right now, so that is a huge benefit to virtual interviews.

According to the AAMC, residency applicants spend a median of $4000 — with a range of $1000 to $13,000 — when you take flights, hotels, and food into account. I was reading a thread on Reddit and fourth-year medical students, not surprisingly, are ecstatic to be saving so much time and money during this application season.

I totally get this. When I was a broke medical student applying, I had an interview in Baltimore and then I took an overnight bus to interview in Boston the next morning. True story.

Another downside is trying to get or give a transparent assessment of a program virtually. I've been reading online about residents trying to find ways to boost transparency and have those candid conversations with applicants right now. You can read about a program online, about the pros and the cons, the culture, priorities, and the values. But let's be real: There's a lot of online marketing glitter. You sometimes have to be there and witness the place to learn about it.

When I was going through the residency process, those social meetups before the interview were my time to get the real deal on programs. In a laid-back atmosphere away from the hospital, residents are more likely to be honest and talk about what they like and dislike about their programs. Applicants want to hear directly from residents. So, in a virtual setting, it's obviously hard.

I'd like to give a shout-out to programs like the one at University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, who took to Instagram to interact with applicants and show them a day in the life. It showed that 95% of their incoming interns in 2020 were following that Instagram page.

One benefit to programs, given that virtual interviews are more accessible, cheaper, and easier to schedule, is that more applicants apply to them. For example, several surgical subspecialties reported a boost in the number of applicants.

Programs are happy, but it makes the process more competitive and cumbersome — match lists and rank lists become longer, selection committees have more work to do, and this makes an already complicated process more complicated.

With increased access to interviews, we could talk about how this virtual process can promote diversity in medicine. Here's a quote from a viewpoint in JAMA : "Virtual interviews may help 'level the playing field' for economically disadvantaged applicants or international medical graduates." Makes sense.

An article in the Neurology journal expands on this thought and says that this marks a time when the residency application process can finally become more holistic and more inclusive.

All in all, I think there will at least be a hybrid virtual model moving forward in the residency application process.

So, I'm curious what you all think. Do you agree with my list of pros and cons? Have you heard any feedback from applicants right now? Would you have preferred a virtual option when you were applying? Let me know.

Alok S. Patel, MD, is a pediatric hospitalist, television producer, media contributor, and digital health enthusiast. He splits his time between New York City and San Francisco, as he is on faculty at Columbia University/Morgan Stanley Children's Hospital and UCSF Benioff Children's Hospital. He hosts The Hospitalist Retort video blog on Medscape.

Follow Alok Patel on Twitter.

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