Research Indicates Virtual Fellowship Interviews Maximize Equity Among Applicants

Written by Erin Covert, MD; Andrew Lewis, MD; Aparna Bhat, MD; Lauren Moore, MD; Neal Chaisson, MD; and Rendell Ashton, MD

Fellowship interviews have historically been conducted almost exclusively in person. However, during COVID-19, medical education governing bodies mandated virtual interviews.1 Since then, studies have investigated applicants’ ability to evaluate aspects of a program via the virtual platform. Based on these studies, we know that there are certain program characteristics that applicants perceive to be better evaluated in person,2,3 some of which heavily influence applicants’ rank lists.4 This is likely why applicants in these studies reported a preference for an in-person component to the interview process.2,3

There are, however, benefits to virtual interviews. In-person interviews require applicants to spend money on travel and lodging, arrange care for dependents, and interrupt their training.5 These can be significant barriers for some applicants, leading to inequities. However, a study of how applicants would actually choose to interview, and the rationale behind this choice had not previously been done. As leaders of the critical care medicine (CCM) and pulmonary/critical care medicine (PCCM) programs at the Cleveland Clinic, we wanted to address this pragmatic question directly.

Study methods

During the 2022 fellowship recruitment cycle, we offered applicants to the PCCM and CCM fellowships their choice of interview format: virtual interview (VI), in-person interview (IPI) or VI with an option for a post-interview in-person visit (VI+). Applicants were also invited to participate in an anonymous pre- and post-interview questionnaire asking about factors influencing their preference, as well as their ability to assess programs through different interview formats.

Eighty-eight applicants agreed to participate. Interestingly, 72% of applicants indicated they preferred to interview in-person (IPI) or to follow their virtual interview with an in-person visit (VI+). But, when it came to actual behavior, most applicants (53%) chose to interview virtually (VI) without an in-person visit (see Figure 1). Only three applicants who chose VI+ came for a follow-up in-person visit.

Figure 1. Pre-interview preferences were selected in the pre-interview survey (62/88 applicants responded). The actual type of interview completed by the 88 applicants is then noted. Though IPI was the interview style noted as preferred by the majority (57% IPI vs 28% VI vs 15.5% VI+), the largest interview style completed was VI (43% IPI vs 53% VI vs 4% VI+).

Understanding applicants’ decisions

In evaluating factors influencing how applicants actually interviewed, we found that those who interviewed virtually (VI) cited cost, travel distance and ability to arrange time away from work as strongly influencing their decision. Applicants who interviewed in-person (IPI) cited the ability to assess program culture and “fit,” hospital facilities and city, and fellow happiness as strong influences.

Almost all fellows (93%) who interviewed in-person were happy with their decision and would have selected the same format again. Only 62% of those who were interviewed virtually (VI) felt the same way. Further, applicants who interviewed in-person (IPI) were overall more confident than those who interviewed virtually (VI) about their ability to assess various factors about a program.

Many studies have assessed trainee interview preference, but our study looked at both trainee preference and actual behavior. We showed that the platform trainees preferred was not necessarily the platform utilized for their interviews. Like prior studies, we showed that 72% of applicants replying to our pre-interview survey preferred an opportunity to visit the facility in some form (whether IPI or VI+). However, only 47% of our applicants actually completed an in-person component for the interview.

From our data, it appears that differences in the interview platform selected by applicants may be influenced by “factors of inequity” (inability to get time off from work, distance to the interview and cost of travel and lodging) versus “factors of opportunity” (degree of interest in the program, the ability to interact with staff and trainees and the ability to see facilities). Applicants who experience factors of inequity seem to select virtual interviews more often, even when it is not necessarily their preferred method of interviewing whereas applicants who enjoy factors of opportunity tend to favor in-person interview formats.

Looking ahead

While these results are not entirely surprising, we did find it interesting that applicants who interviewed with an in-person component seemed to have a very different experience and level of confidence about the interview than those who interviewed virtually. This was despite our attempts to standardize our interview day, so all applicants received a similar experience, regardless of format. For us, this highlighted the complexities in ensuring equity to all applicants when considering various forms of hybrid interviewing which include both virtual and in-person options.

Our data show that most applicants still prefer in-person interactions during the interview process. However, when it comes to what interviews were selected, factors of opportunity versus inequity carry significant weight. Factors of inequity prevented many applicants from pursuing an interview with an in-person component and, in many cases, led to an interview experience that resulted in lower confidence about the program compared to that of in-person applicants.

We concluded that although most applicants may prefer an interview with an in-person component, virtual interviews likely maximize equity among applicants, thus leveling a highly competitive playing field, and equalizing our ability to recruit trainees based on merit rather than social opportunity.

Bibliography:

1) AAMC. 2022. AAMC Interview Guidance for to 2022-2023 Residency Cycle. December 2, 2022. https://www.aamc.org/about-us/mission-areas/medical-education/aamc-interview-guidance-2022-2023-residency-cycle.

2) Allam JS, BurkartKM, & Coruh B et al. The Virtual Interview Experience: Perspectives of Pulmonary and Critical Care Fellowship Applicants. ATS Scholar. 2022; 3(1):76-86.

3) Huppert LA, Hsu G, & Elnachef N et al. A Single Center Evaluation of Applicant Experiences in Virtual Interviews Across Eight Internal Medicine Subspecialty Fellowship Programs. Medical Education Online. 2021;26:1946237.

4) Pretorius ES & Hrung J. Factors that Affect National Resident Matching Program Rankins of Medical Students Applying for Radiology Residency. Acad Radiol. 2002; 9:75-81.

5) Coruh B. Point: Should Fellowship Interviews Remain Exclusively Virtual? Yes. CHEST. 2021; 160(4): 1184-1186.