Education Research: Virtual Residency Interviews and the Second Look

Discussion

In the wake of the COVID-19 pandemic, residency programs continue to develop strategies to best construct the ideal interview experience for applicants and programs. Virtual interviews cut travel-related interview expenses for applicants, which historically have amounted to several thousands of dollars, allowing applicants to consider more residency programs.⁵ Of importance, the virtual format has the potential to improve equity and access for less privileged applicants.² Virtual interviews alone can fall short, however, in providing candidates a true understanding of program culture and the local environment and community where they will be spending the next several years.^1,3 Our results show that second-look attendees find an in-person experience valuable in determining their rank order list. Virtual interviews have not been able to convey important factors for applicants that can be done with in-person events including campus tours, ability to see the geographic area, and interactions with current residents.

The results of the 2022 Neurology Residency Matching Program Applicant Survey illustrated the importance of geographic location and “perceived goodness of fit” for neurology applicants when evaluating programs.⁴ These were the driving factors that led many interviewees to participate in second-look events hosted by Mayo Clinic’s Adult Neurology Residency Programs during the 2023 Match cycle. While participation was not universal among applicants, the most significant barriers included time and money, not disinterest. To provide the most equitable experience possible, programs may help to mitigate these barriers by subsidizing hotel accommodations and meals during the event. In addition, more advanced notice regarding the timing of such events may help applicants plan their schedules accordingly to facilitate participation. The Mayo Clinic sites that defrayed accommodation costs and provided earlier notification experienced greater participation among applicants in their on-campus events. Demographic data were not solicited in the survey to preserve respondent confidentiality, limiting examination of potential disparities affecting attendance at the Arizona, Florida, and Minnesota second-look events.

Assessment of culture and fit is difficult in the virtual space and may drive applicants to embark on self-guided visits if formal events are not offered by programs. While these events may add additional time and financial burden on residency programs, they also offer the opportunity to craft an itinerary highlighting unique program strengths and regional attributes that may not be adequately showcased during a virtual interview day. Most second-look attendees (91%) reported that they would encourage future applicants to participate in such events, which highlights the perceived value from an applicant standpoint. Future studies further examining the value of these events from the perspective of the residency programs would be insightful. By design, the no-stakes second-look visits had no effect on program rank lists.

Despite clear communication and centralized safeguards to ensure that Mayo Clinic Neurology second-look events were optional and would have no impact on ranking of applicants, nearly half of attendees were not confident that this was the case. The visible engagement of program leadership in the second-look activities and the lack of a means for applicants to verify program rank list completion may have contributed to applicant doubt in the no-stakes nature of these visits. Thus, in addition to implementation of measures to ensure visits are truly “no-stakes,” these measures should be transparently and verifiably communicated to future applicants. One proposed solution put forth by the Coalition for Physician Accountability and the Organization of Program Directors Association is the voluntary locking functionality for program rank order lists. This would require programs to certify their rank order lists before applicants and provide a specified time window for applicants to visit programs of interest without concern that such visits can affect program rank lists.⁶

Our results from the Mayo Clinic Neurology Residency experience during the 2023 Match cycle was similar to that of the University of Cincinnati Radiology Residency experience during the 2022 Match cycle. Reasons driving attendance and the perceived benefits were comparable.⁷ Like the University of Cincinnati experience, the Mayo Clinic Neurology in-person second-look visits had a profound impact on attendees. Almost half of Mayo Clinic Neurology second-look participants changed their rank order list after the visit. Helping future adult neurology residents make more informed decisions about where they spend the next 3–4 years of their lives may have significant downstream consequences on program retention and overall educational outcomes. Further studies would be helpful in assessing whether an in-person visit during the interview season influences future resident satisfaction with their matched program and attrition rates and whether adoption of second looks would increase if barriers identified by our survey were mitigated.

While the survey population was from 3 administratively and geographically distinct Mayo Clinic Neurology programs, the results may not be generalizable to all programs and institutions. Demographic data and geographic distance from the hosting institution were not collected in the survey and may have provided additional information on variables affecting participation in the events. The relatively small sample size and low survey response rate are additional limitations that may affect broad generalization of the findings. However, the fact that no survey respondents who attended a Mayo Clinic Neurology second-look event would discourage future applicants from attending illustrates the potential value for interviewees. Further strategies to enhance equity and mitigate barriers to attendance will be important next steps for the education community.