Medical Education

Every Residency Program Should Offer Virtual Interviews

In the “before times”, all interviews for residency and fellowship positions were performed in-person. Then came COVID when in 2022, 94% of programs offered virtual interviews exclusively and an additional 4% of programs performed more than three quarters of interviews virtually. With the pandemic fading, programs are facing the decision of whether to return to in-person-only interviews. There are compelling reasons why they should not.

The advantages of the in-person interview

I have interviewed hundreds of students applying to residency and residents applying to fellowship. As a faculty member who served for many years on our internal medicine resident selection committee and our pulmonary and critical care fellow selection committee, I believe that in-person interviews are usually preferable to virtual interviews.

For the interviewer, you get better information about the applicant’s communication skills, both verbal and non-verbal. It is also insightful to observe how the applicants interact with other applicants being interviewed on the same day and how applicants interact with the non-physician members of the office staff. The in-person interview day usually includes a lunch or dinner with some of the current residents or fellows – this is a time when applicants often reveal more of their true personality and behavior. All of these observations can impact how high an applicant is ranked on the program’s match list.

For the interviewees, an in-person interview is an opportunity to see what the facilities are like. This can include the layout of the hospital(s), inpatient rooms, outpatient clinic sites, the educational facilities, the call rooms, the library, and even the cafeteria. The applicant can get a better idea of how the current residents interact with each other, with the faculty, and with the hospital staff. One of the most overlooked advantages of in-person interviews is the opportunity to talk with other applicants being interviewed on the same day – they can often provide first-hand knowledge of other training programs and that knowledge can help an applicant decide which additional programs to interview at (or not interview at).

But in-person interviews are costly

The main disadvantage of in-person interviews is the cost – both to the applicant and to the residency (or fellowship) program. For the applicant, the time cost of each interview is considerable. To interview at a residency program within a 2-3 hour drive requires a full day to drive to that program, interview, and drive back home. To interview at a residency program farther away, it can take 2 or 3 days when factoring in travel time. This means that the senior medical student must either make arrangements to be absent from their clinical rotation for that time period or to schedule a vacation month and try to fit as many interviews into that month as possible. In addition to the time cost, there is considerable financial cost for each interview. The travel costs for interviews that the applicant can drive to are relatively low but for those interviews that require an air flight to reach, costs can add up quickly. This is especially true if an overnight hotel stay is necessary. For many applicants, there is a wardrobe cost – medical students who have been wearing kakis or scrubs with a white coat for clinic rotations for the past couple of years need to buy one or two sets of business wear for interview days. To successfully match to a residency program, students must interview at an average of 14 programs, costing them thousands of dollars in travel and wardrobe expenses. Because 71% of medical students owe debt on educational loans (with the average amount of those loans about $200,000), most students have to take out additional loans just to go to in-person interviews.

Interviews are also expensive for residency programs. A staff member must be dedicated to chaperone the interviewees and coordinate all of their schedules. Programs must usually pay for a lunch and/or dinner for the interviewees. Many programs will also cover the cost of a hotel room for interviewees traveling from out of town.

The greatest advantage of virtual interviews

In the past, here at the Ohio State University, we did not get a lot of residency applicants from students at west coast medical schools – it was just too costly for them to travel to Columbus to interview. An interview generally would require three days for a west coast medical student – one to fly to Columbus, one to interview, and one to fly back to the west coast. Instead, most of our applicants came from midwestern medical schools where applicants could drive to Columbus – often making the roundtrip drive on the same day as the interview.

For residency programs, the greatest advantage of virtual interviews is that they give you access to a larger pool of applicants. This allows the program to be more selective about the applicants that the program decides to offer interviews to and rank on the program’s match list. For some residency programs, this can mean interviewing more students with high medical school grades or test scores. For other programs, it can mean interviewing more students who fit best into the residency program. As an example, some residency programs emphasize didactic teaching whereas others emphasize more hands-on autonomy in patient care. One applicant may thrive in a residency program with a lot of lectures and research opportunities whereas another applicant may thrive in a residency program that requires residents to function more independently in patient care.

For applicants, the greatest advantage of virtual interviews is that they improve the chance that you get into a residency program that you will be happy and successful in. The most important factor in choosing a particular residency program is whether that program will allow you to reach your greatest potential as a doctor. In turn, that requires two things: the program must match your preferred method of learning and you have to enjoy being around the people that you work with. To learn any skill requires a combination of three things: observing experts, didactic education, and practice. For example, to learn how to golf requires watching how golf pros play the game, taking golf lessons, and then getting on the course and practicing. Medicine is the same but each of use has our own personal optimal ratio of observation to didactic education to practice. Finding a residency program with that offers a similar ratio of these three to your personal optimal ratio is the key to reaching your potential. The residency program that is optimal for one student may not be optimal for another student. But no matter how well a residency program fits your mode of learning, if you do not like the people that you are working with, you can never reach your fullest potential. Using virtual interviews allows the student to expand the geographic area of residency programs they consider and increases the chance of finding programs that best match the student’s preferred mode of learning, that has other residents the student enjoys being with, and has faculty that the student would like to have as mentors.

My recommendations

For residency programs: When feasible, do in-person interviews – you will get more information about an applicant than you can by a virtual interview. But offer virtual interviews as an option, especially for those applicants who would otherwise not apply to your program if in-person interviews were mandatory. For example, offer out-of-state medical students the option of either in-person or virtual interviews. Or offer virtual interviews to students living more than 120 miles away. For a residency program in Seattle, the best candidate might be a medical student in Florida but there is little chance that student is going to even apply for residency if it would require flying across the country for an in-person interview. Your future chief resident might be a senior student currently in a medical school 2,500 miles away.

For medical students: When feasible, do in-person interviews. You will learn more about the facilities and the people you will be working with than you can get from the residency program’s website and virtual interviews with two or three faculty members. You can often improve your chances of getting into a residency program because an in-person interview can make you more of a known entity to the program. Interviewing in-person can also indicate your interest in the program since you took the time and expense to travel for the interview. But take advantage of interviewing virtually for those residency programs that you would not have applied to if it required traveling for in-person interviews. This can allow you to interview at more programs that you would have interviewed at had you needed to travel to for in-person interview. It can also save you money for interviewing at residency programs that you would otherwise need to fly to. For more information, see my previous post on making the most of your virtual interview.

Remember who you are competing with

The purpose of a residency program’s resident selection committee is to identify and recruit the best possible medical students. Each residency program competes with all of the other residency programs for those best students. The residency program that offers virtual interviews has a competitive advantage over programs that only offer in-person interviews.

The reason a medical student interviews with multiple residency programs is to get into the residency that he or she is going to learn best in and be happiest in. Each student is competing with all of the other students for the best residency programs. The student that interviews virtually at geographically distant residency programs has an advantage over students who are only willing to do in-person interviews.

April 12, 2024

By James Allen, MD

I am a Professor Emeritus of Internal Medicine at the Ohio State University and former Medical Director of Ohio State University East Hospital