MD & DO Bring back in-person interviews

[LucidSplash]

As someone who personally did in person interviews for medical school, residency, fellowship, and for post-training jobs, as well as zoom interviewed for post-training jobs, and as someone who grew up below the poverty level and for whom all those in-person interviews required very careful balancing of finances but still required taking on additional credit card debt, AND someone who has interviewed students/trainees both in-person and via zoom:

I don’t think in-person interviews gave all that much of a different exposure or “feel” for a place. After the 6th or 7th in person interview, all the things I thought I would remember about each place just blurred together. In-person interviews are a lot of pageantry on the part of the program and the applicants alike. The places that couldn’t hold it together for a few in-person hours to appear non-toxic couldn’t do that via zoom either. Same is true for the applicants.

Ultimately I think a hybrid approach would be best. A limit on applications to fix the ridiculous glut of applications or a tiered system where you can apply to more places as you receive rejections or choose not to schedule interviews, coupled with a requirement for programs to formally accept or reject applicants for interviews within a constrained time period after receiving the application, remote interviews for all applicants, followed by a limited number of spots for applicants to do an in-person 2nd look, paid for by the program, after the programs submit their rank lists, so that it doesn’t affect program of applicant interest.

And I’m not even going to further touch the comments regarding people who grew up socioeconomically disadvantaged being statistically less likely to handle medical training. Oh wait, yes I will. Given all the extra financial hurdles I had to handle just to manage getting the resume to apply to medical school including finding time for extra-curriculars while working, and going to school full-time, working a “real job” for a few years to be able to afford to apply to medical school and self financing the entire process, and having zero extra family support during residency and fellowship and the brief period of time I took off between finishing fellowship and starting my first attending job (very limited because I needed money and couldn’t afford to take 3 months off as was suggested, to the point that my employer recommended I “take a loan from my family” in one of the most ridiculous classist things ever said to me outright), I observed how other students, trainees, and brand new attendings handled the pressures of school, training, and early attendinghood along the way, and statistically speaking I handled it better. The “real world” wasn’t a shock to me and I didn’t make poor financial decisions that I saw many (not all by any means but many) contemporaries make. GTFO with the “grew up more affluent and more likely to handle surgical training better” nonsense. By the time I interviewed for residency, I had spades more “real world” experience and financial management experience than my contemporaries that had more in the way of “means” and it still required that I take on credit card debt to apply in person for general surgery. I literally gave the effing lecture on “financial tips and tricks to manage interview expenses” to the class below me for heavens sake. So if I had significant financial pressures associated with in person interviews, it had nothing to do with having poor financial management skills.

To the person who posted this, I really respect most of your posts. But it seems based on your worldview, I shouldn’t have been given the opportunity to be a surgeon, unless I was willing to take on credit card debt. And honestly, the only other response I have for that are 4-letter words.

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[aldol16]

And this happened when we were interviewing in person too. Do you know of any data that shows this is happening more frequently today than when we did in person interviews?

How would any data like that exist? Have you talked to people who matched during the COVID years when all interviews were virtual and how difficult it was to choose a place? In my specialty, the number of interns that year who either quit or were fired was definitely higher than other years. Created a whole lot of movement between programs.

 

[aldol16]

You make it seem like you will know a place by spending 2-3 days max there. Your adaptability matters a lot more.

It's a spectrum. You'll get a better sense of the place by spending 2-3 days there more than you would sitting through Zoom days with pictures on slides.

 

[Ho0v-man]

How would any data like that exist? Have you talked to people who matched during the COVID years when all interviews were virtual and how difficult it was to choose a place? In my specialty, the number of interns that year who either quit or were fired was definitely higher than other years. Created a whole lot of movement between programs.

I was one. It wasn’t a problem. Do you have data on an increased attrition of interns that year, or is that just in your specific program? Also, was it just that year? Lots of students suffered from a truncated clinical education from Covid.

I’m inclined to agree with another poster. The only way to really get to know a program/applicant is through an away rotation. Interviews are just a sales pitch both ways, which is pretty much the same online or virtual. Prob 99% of people rank based on location and prestige anyway.

 

[LucidSplash]

How would any data like that exist? Have you talked to people who matched during the COVID years when all interviews were virtual and how difficult it was to choose a place? In my specialty, the number of interns that year who either quit or were fired was definitely higher than other years. Created a whole lot of movement between programs.

I’m sure the misery inflicted on healthcare workers during the height of a COVID played a part in this anecdotal increase in attrition. Would be tough to remove such confounding factor. And would also need to be compared against historical averages over a period of years.

 

[differentiating]

As someone who did residency interviews in-person and fellowship interviews virtually - agreeing that virtual interviews are way better from an applicant's perspective. I took on an extra couple of thousand in loans to cover the costs of traveling for prelim + advanced interviews in residency, and didn't pay a dime for fellowship, and I didn't feel that I was missing out on anything useful in the latter case. Plus I'd much rather interview in the comfort of my own home, so it was less stressful as well.

I agree that second looks should be offered for those who want them, but virtual interviews & lectures were some of the good things to come out of the pandemic imo.

 

[collegestud2013]

I agree! I think there should be virtual and in person options to be cognizant of those with financial constraints but still give applicants the ability to put their best foot forward for interviews they may value more if money is limited.

This would pressure applicants to go in person who otherwise might not have, as those interviewing virtually may be seen as not being as interested in a program as someone who goes in-person. Some have suggested having option in person visiting session later in the app season AFTER programs have already submitted their ranks but before applicant ranks are due.

For most people, virtual interviews provide 90%+ of the benefit of in person interview but at a small fraction of the cost and significantly less travel time.

Capping numbers of interviews for a given specialty could be a solution so a few strong applicants don't take up an excessively large number of interview spots.

Virtual interviews also probably do allow more malignant residency programs to more easily hide their negatives. And they bias programs to take more of their in-house/internal candidates who they have met in person. This can obviously be a pro for weaker applicants who have strong ties to their in-house program in a competitive specialty (at the expense of stronger external candidates).

 

[Kierkegaard's Bud]

It's a spectrum. You'll get a better sense of the place by spending 2-3 days there more than you would sitting through Zoom days with pictures on slides.

Don't think the differential is worth $1K in travel and other costs.

 

[Esmolol]

This would pressure applicants to go in person who otherwise might not have, as those interviewing virtually may be seen as not being as interested in a program as someone who goes in-person. Some have suggested having option in person visiting session later in the app season AFTER programs have already submitted their ranks but before applicant ranks are due.

For most people, virtual interviews provide 90%+ of the benefit of in person interview but at a small fraction of the cost and significantly less travel time.

Capping numbers of interviews for a given specialty could be a solution so a few strong applicants don't take up an excessively large number of interview spots.

Virtual interviews also probably do allow more malignant residency programs to more easily hide their negatives. And they bias programs to take more of their in-house/internal candidates who they have met in person. This can obviously be a pro for weaker applicants who have strong ties to their in-house program in a competitive specialty (at the expense of stronger external candidates).

Many specialties have a “soft cap” in form of signals. As far as I know, most interviews in anesthesiology come from signals and only very few people that I know have gotten invitations outside of their signal pool.

I personally am a little bit afraid that caps limit candidates chances of matching to the best program the candidate can match. Having a cap of 15 interviews one cannot just apply to all top institutions and hope to get into one. It becomes more about picking and choosing and then having to allocate signals for safety programs as well.

 

[bGMx]

Tiered approach to interview season as outline above is where I would put my vote.

 

[Captain_Falcon]

Many specialties have a “soft cap” in form of signals. As far as I know, most interviews in anesthesiology come from signals and only very few people that I know have gotten invitations outside of their signal pool.

I personally am a little bit afraid that caps limit candidates chances of matching to the best program the candidate can match. Having a cap of 15 interviews one cannot just apply to all top institutions and hope to get into one. It becomes more about picking and choosing and then having to allocate signals for safety programs as well.

You can apply to 100 programs, including the top X and if you get > 15 interviews just cancel

 

[coffegroundemesis]

Too many folks to reply to all individually, but since the sentiments were similar will sort of lump it all into one.

I suppose I simply prioritize fairness and equity differently. I’d rather lose out on some applicants of limited means rather than forfeit the ability to meet prospective applicants in person and gauge their fit. Getting good people who fit in well is far more important to me than being accessible to everyone.

Plenty of applicants with limited means have managed to interview in person and become good surgeons for decades. I fail to see why they are suddenly going to fall by the wayside now unless we let them interview over zoom.

I do stand by the concept that weeding out some people whose means and management skills are so poor that they can’t manage to attend interviews is likely a net benefit to programs. When I’ve seen trainees struggle, it’s often factors outside the hospital driving it. Certainly financial struggles can be one of those factors, and I would wager that someone so on the margin that they can’t manage a few economy flights after saving a bit from 4 years of federal loans or taking out some private loan or leveraging CC miles or whatever would be more likely to struggle in training.

Obviously nobody has rigorously studied this, but I don’t think we need yet another paper confirming the obvious. It’s not just a matter of rich or poor, it’s a matter of ability to plan and manage what resources you have. If one were to do a paper on this, you wouldn’t necessarily look at income or parental income, but rather things like credit score or history of bankruptcy or default or eviction or something. In fact I do recall a small paper about this a few years ago getting a lot of flack, but finding that credit score actually did seem to have some association with performance.

Sure, this all flies in the face of the equity uber alles mantra, but I find there are more important things to consider.

Moderator edit. Unacceptable in this or any other forum.

 

[Esmolol]

You can apply to 100 programs, including the top X and if you get > 15 interviews just cancel

You really are on the spectrum.

Please be nice to others. People with ASD are not worse than people who are not neurodivergent.

 

[Med Ed]

Many specialties have a “soft cap” in form of signals. As far as I know, most interviews in anesthesiology come from signals and only very few people that I know have gotten invitations outside of their signal pool.

I personally am a little bit afraid that caps limit candidates chances of matching to the best program the candidate can match. Having a cap of 15 interviews one cannot just apply to all top institutions and hope to get into one. It becomes more about picking and choosing and then having to allocate signals for safety programs as well.

It's a shame that current medical students never got to experience the match before overapplication consumed everything. With a much higher ratio of signal-to-noise, applying to 25 programs and getting 20 interviews was not uncommon. Of course, you'd have to cancel about half of them due to the physical limitations of travel.

Preference signaling may be the way out of the current mess, but right now it seems that specialties are reluctant to grant many signals to applicants. I suppose they like the ability to narrow the pool very quickly, but it does become very difficult for applicants to distribute them. I personally think 20-25 would be a decent number, but who knows if that will ever happen.

 

[Captain_Falcon]

I think for competitive fields, the more "signals" the better. For less competitive fields, the less signals needed. For example, I imagine fields like surgical subspecialties, derm, radiology, OBGYN, anesthesia (based on last year) should have no less than 20 signals. Fields like FM, Peds, PM&R, Psych, Neuro, Path should probably have between 5-10. Large fields like IM would probably want somewhere in the middle.

My field of Neurology has only 3 signals. I think that is too few.

 

[Angler]

It's a shame that current medical students never got to experience the match before overapplication consumed everything. With a much higher ratio of signal-to-noise, applying to 25 programs and getting 20 interviews was not uncommon. Of course, you'd have to cancel about half of them due to the physical limitations of travel.

I applied to only 8 IM residencies as a non-traditional (2 gap years post MD) through the match. I got 8 interviews and matched at my top choice. They were all in the Bay Area. That boat has sailed!

 

[Mr.Smile12]

FYI

Impact of Preference Signals on Interview Selection Across Multiple Residency Specialties and Programs

Background Program signaling is an innovation that allows applicants to express interest in specific programs while providing programs the opportunity to review genuinely interested applicants during the interview selection process.Objective To examine the influence of program signaling on...

meridian.allenpress.com

 

[NotAProgDirector]

I think for competitive fields, the more "signals" the better. For less competitive fields, the less signals needed. For example, I imagine fields like surgical subspecialties, derm, radiology, OBGYN, anesthesia (based on last year) should have no less than 20 signals. Fields like FM, Peds, PM&R, Psych, Neuro, Path should probably have between 5-10. Large fields like IM would probably want somewhere in the middle.

My field of Neurology has only 3 signals. I think that is too few.

I don't think it's quite this straightforward. First, it depends upon whether you're trying to make it better for programs, or for applicants. Although ideally the answer is "both", there will be some imbalances.

What we know is:
Signalling programs increases the chances of getting an interview (but not guaranteed)
Signals are not evenly distributed amongst programs. In general, 50% of the signals go to 25% of the programs. So what happens is that some programs get lots of signals, and others get very few. If too many or too few of a program's applicants signal, it doesn't help those programs much -- either way, they still need to review all the apps in detail (or use some screening process) to pick their invites.

So:

If you increase the number of signals enough, you get a defacto application cap. Programs will simply only look at signaled applications. The "top programs" (however measured) will likely get all signaled applications, and hence the process will be useless to them and to applicants (although not signaling would essentially end your application, signaling doesn't really "help").

When the number of signals is very small, the impact to programs is small -- they will only get a small number of signals, and likely will consider those applicants strongly. So "good" for applicants. But programs will still need to sift through all the non-signaled apps, so "bad" for programs.

The middle seems like the best, but the problem is that the signals do not distribute evenly. So you still end up with some programs in the "too many" and others in the "too few" groups. Perhaps advertising how many signals each program gets would make applicants more likely to send them to programs with fewer -- figuring it's a "better bet".

The idea being proposed by IM is to try to have both - more signals, with a few gold and the rest silver. Not clear that's going to work either - again more signals will push some programs from "just right" to "too many", but perhaps some from "too few" to "just right".

No perfect solution

 

[JuicedToTheSocks]

As someone who personally did in person interviews for medical school, residency, fellowship, and for post-training jobs, as well as zoom interviewed for post-training jobs, and as someone who grew up below the poverty level and for whom all those in-person interviews required very careful balancing of finances but still required taking on additional credit card debt, AND someone who has interviewed students/trainees both in-person and via zoom:

I don’t think in-person interviews gave all that much of a different exposure or “feel” for a place. After the 6th or 7th in person interview, all the things I thought I would remember about each place just blurred together. In-person interviews are a lot of pageantry on the part of the program and the applicants alike. The places that couldn’t hold it together for a few in-person hours to appear non-toxic couldn’t do that via zoom either. Same is true for the applicants.

Ultimately I think a hybrid approach would be best. A limit on applications to fix the ridiculous glut of applications or a tiered system where you can apply to more places as you receive rejections or choose not to schedule interviews, coupled with a requirement for programs to formally accept or reject applicants for interviews within a constrained time period after receiving the application, remote interviews for all applicants, followed by a limited number of spots for applicants to do an in-person 2nd look, paid for by the program, after the programs submit their rank lists, so that it doesn’t affect program of applicant interest.

And I’m not even going to further touch the comments regarding people who grew up socioeconomically disadvantaged being statistically less likely to handle medical training. Oh wait, yes I will. Given all the extra financial hurdles I had to handle just to manage getting the resume to apply to medical school including finding time for extra-curriculars while working, and going to school full-time, working a “real job” for a few years to be able to afford to apply to medical school and self financing the entire process, and having zero extra family support during residency and fellowship and the brief period of time I took off between finishing fellowship and starting my first attending job (very limited because I needed money and couldn’t afford to take 3 months off as was suggested, to the point that my employer recommended I “take a loan from my family” in one of the most ridiculous classist things ever said to me outright), I observed how other students, trainees, and brand new attendings handled the pressures of school, training, and early attendinghood along the way, and statistically speaking I handled it better. The “real world” wasn’t a shock to me and I didn’t make poor financial decisions that I saw many (not all by any means but many) contemporaries make. GTFO with the “grew up more affluent and more likely to handle surgical training better” nonsense. By the time I interviewed for residency, I had spades more “real world” experience and financial management experience than my contemporaries that had more in the way of “means” and it still required that I take on credit card debt to apply in person for general surgery. I literally gave the effing lecture on “financial tips and tricks to manage interview expenses” to the class below me for heavens sake. So if I had significant financial pressures associated with in person interviews, it had nothing to do with having poor financial management skills.

To the person who posted this, I really respect most of your posts. But it seems based on your worldview, I shouldn’t have been given the opportunity to be a surgeon, unless I was willing to take on credit card debt. And honestly, the only other response I have for that are 4-letter words.

Let's be honest, unless you're doing a sub I, there is very little 'deeper' information you'll be able to pick up by making everyone take out loans or asking mommy and daddy for money. Everyone will be on their best behavior regardless.

Not at all surprised to see the people who staunchly advocate for DEI not give a sht when it comes to the most important disadvantage imaginable, socioeconomic status.

 

[Med Ed]

I can't stand virtual meetings. When COVID happened I saw them as a necessary evil, but in my view they don't hold a candle to in-person interactions.

So when this debate started my reflexive opinion was to favor the gradual return of in-person interviews. They seemed like the ultimate mutual preference signal and the best way to exchange information at a key juncture in life.

But after hearing countervailing viewpoints, and comparing match data from 2019 and 2022, it became apparent that virtual interviews don't seem to harm the process. And they save everyone a lot of time and money. So let's keep doing them.

The match is essentially a zero sum game, and the majority of programs and applicants are fairly interchangeable. Many different possible match outcomes will therefore satisfy both parties.

 

[DarkBluMage]

I can't stand virtual meetings. When COVID happened I saw them as a necessary evil, but in my view they don't hold a candle to in-person interactions.

So when this debate started my reflexive opinion was to favor the gradual return of in-person interviews. They seemed like the ultimate mutual preference signal and the best way to exchange information at a key juncture in life.

But after hearing countervailing viewpoints, and comparing match data from 2019 and 2022, it became apparent that virtual interviews don't seem to harm the process. And they everyone a lot of time and money. So let's keep doing them.

The match is essentially a zero sum game, and the majority of programs and applicants are fairly interchangeable. Many different possible match outcomes will therefore satisfy both parties.

I just think it should be a choice for applicants.

 

[MateoGM416]

Not at all surprised to see the people who staunchly advocate for DEI not give a sht when it comes to the most important disadvantage imaginable, socioeconomic status.

Huh? Who are you referring to specifically? Is race not part of one's SES? I support DEI and virtual interviews and I would wager that most people who support DEI would also support virtual interviews, but perhaps not necessarily vice versa.

 

[aldol16]

Don't think the differential is worth $1K in travel and other costs.

Disagree. Worth it to make a good decision that will affect your life for the next 3+ years.

 

[MateoGM416]

Disagree. Worth it to make a good decision that will affect your life for the next 3+ years.

Some of us are going through school with nothing in our bank accounts to be dropping $1k for something that could be done over zoom.

 

[LucidSplash]

Disagree. Worth it to make a good decision that will affect your life for the next 3+ years.

And as many of us who have done both have attested, doesn’t make that much of a difference in the decision-making process. You really don’t get a better feel for a place on an in-person interview day. It’s a lot of pageantry no matter which way you do it.

 

[aldol16]

And as many of us who have done both have attested, doesn’t make that much of a difference in the decision-making process. You really don’t get a better feel for a place on an in-person interview day. It’s a lot of pageantry no matter which way you do it.

Again, disagree.

 

[JuicedToTheSocks]

Disagree. Worth it to make a good decision that will affect your life for the next 3+ years.

That's what second look is for... or if you're so inclined you can fly out and interview from a library or something, call it a vacation. Making every single applicant fly around the nation is ridiculous... we're in 2024...

 

[mistafab]

“Bring back in person interviews”

No thank you.

Even job interviews at academic joints for professorship are virtual in the first round or two. They fly you out all expenses paid after that.

Cats out of the bag. Good riddance.

 

[RangerBob]

I enjoyed all in-person interviews. I got a much better impression of the program than I could have received from virtual interviews. You can interact more with the current residents, watch their facial expressions when you're just sitting around, waiting for your interview to start. Same for attendings and program staff. As structured as interview days were before, a virtual interview is significantly more structured as now you can only look at what the camera is pointed at.

It's significantly harder to make a connection with someone over Zoom. You're not talking to a real person--just a projection of one. Nothing can fix that.

I do agree with everyone that interviews get quite costly. I had to take out a private loan to fund mine. In the end I think it was worth it as I was very happy with where I matched.

I get the argument though. Not everyone can/wants to take out more loans to fund interviews.

I will say however, that was my favorite part of med school. I scheduled easier rotations for Nov-Jan (we all did) that allowed sufficient time off, so my wife and I basically had 15 or so small vacations and got to explore places we'd never been. We drove most everywhere and really had a blast.

 

[MDMechEngr]

There may come a day when you put on a virtual head set and find yourself in a virtual room with everyone else just as if you were there in-person for the interview. No more in person interviews please. Had to fly across the country 10 times for med school interviews and no thank you.

 

[Mr.Smile12]

There may come a day when you put on a virtual head set and find yourself in a virtual room with everyone else just as if you were there in-person for the interview. No more in person interviews please. Had to fly across the country 10 times for med school interviews and no thank you.

I would guess before the end of the decade. The technology exists now.