Fellowship interviews in the COVID-19 era: an opportunity for lasting change

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Author:

Eduardo Hariton, M.D., M.B.A.1

1University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences

Consider This:

The COVID-19 pandemic has disrupted plans to hold in-person, reproductive endocrinology and infertility (REI) fellowship interviews. Current recommendations to practice social distancing and limit non-essential travel have necessitated the in-person interview evolve into a video-based teleconference. While this may seem like a temporary accommodation to mitigate an acute disruption, it is an opportunity to accelerate the modernizing of an increasingly antiquated interview process.

The last leap forward in updating how we interview and select candidates for fellowship has been in the digitizing of paper-applications and creation of an online portal for submission, the Electronic Residency Application Service (ERAS). Unfortunately, we have not yet taken the next logical step - utilizing the power of the internet to facilitate the interview and selection process itself, not just the submission of the application. This interview season can be the bridge between the old way and the future of REI fellowship interviews. 

Video interviews (VI) in both residency and fellowship interviews are not new (1). A randomized trial of VI in Urology found that both applicants and faculty favored using VI as an adjunct to on-site interviews, and that using this approach resulted in applicants spending significantly less time away from their home institutions (2). In addition to time away from clinical duties, in-person interviews are also associated with a significant financial cost.  A study of general surgery residents applying to fellowship showed that 62.3% spent over $4,000 and 21.7% spent over $8,000 for fellowship interviews, with most missing more than 7 clinical days (3). Other studies have shown that VI saved both applicants and programs over $500 per applicant, per interview, with favorable results (4). Given that the high cost of in-person interviews unequally burdens applicants of lower socioeconomic status, VI can also help level the playing field for applicants who cannot afford to travel to multiple on-site interviews.

While VI’s have the opportunity to benefit all parties involved, its adoption has been slow and circumspect. Concerns cited include the inability for applicants to adequately represent themselves, inability to see the program facilities in-person, and wariness of utilizing new technology, among others (3). Despite these concerns, multiple surgical fellowship programs have already published on their successful execution of fully remote fellowship interviews during the COVID-19 pandemic (5). As REI fellowship programs move to create a VI template and implement it this interview season we outline a framework of best practices that a fellowship program can consider as they prepare.

Prior to the interview:

  • Create a video: Showcase faculty and fellows introducing the program’s highlights and taking applicants on a video tour of your clinical spaces: This will allow applicants to get a better sense of the program and see the facilities. Take care to ensure patient and staff privacy during the filming of any patient care areas.
  • Virtual social gathering: Despite applicants not being on site, a social gathering with trainees should still be encouraged via video conferencing, as this part of the process is, anecdotally, of high value to applicants in understanding the culture of the program. These gatherings are likely best facilitated by fellows to allow for a casual atmosphere where applicants can ask questions freely. This can occur the night prior to the interview or after the interview. Depending on the number of interviewees, it can be help with one large session or multiple smaller ones, preferably under ten participants per session to maximize interaction with all applicants.
  • Updated Information: Applicants will seek information about the program virtually so it is important to make sure the information shared online is accurate and complete. Updated program websites to reflect this change towards VI this interview season will be essential. Slides or handouts that are routinely shared on interview day can be made available to interviewees beforehand.

During the interview day:

  • Personalized interview schedule: Having a schedule with direct, personalized links will go a long way to ensuring interviews happen smoothly. Nonetheless, always include backup phone numbers in case interviewers and applicants cannot connect via VI.
  • Consider the setting: Provide individual, password-protected, video conference rooms for each interviewer: Making sure the VI’s are conducted in a safe platform will ensure privacy for all parties involved.
  • Technical support: In the same way that in person interviews require a chaperone to make sure applicants get to their interviews, it is important to have technical support available on-site to troubleshoot any technological issues that may arise with VI.
  • Digital Materials: Handouts such as employment contracts, that are typically provided in person, should be available electronically. This represents an opportunity to share key information with applicants and fulfill ACGME requirements in an environmentally friendly fashion. A “share-screen” approach to an introductory presentation made by a faculty member is also encouraged.

After Interview day:

  • Wrapping-Up: It can be expected that there will be more follow up questions than after in person interviews, so make sure there is an avenue for applicants to seek answers to these. A closing Q&A forum with the program director and/or fellows may help to minimize additional email follow-ups.
  • Debrief: Organize an interviewer debrief and assign someone to lead the session. Large group discussions are harder to conduct virtually than in person, so it is wise to have a set format and leader.
  • Collect feedback: It is imperative to learn from both the interviewer and interviewee experience, so that the process can continue to be improved for all parties involved. Consider a pre- and post-interview day survey to refine your interview day strategy if more than one interview day is conducted per season.

While the COVID-19 pandemic has accelerated the need for this transition, this is a positive move in the right direction for the field. VIs are not a substitute for in-person interviews, and an on-site visit will and should still be part of the fellowship application process once it is safe to do so again. Nonetheless, VI can be used as an option for those who can’t afford to or can’t get the days off clinical duties to travel on-site, or as an adjunct to in-person interviews. In the latter case, a program could screen future on-site applicants and have only a limited number where both parties remain interested in travel for in-person interviews. This model would allow programs to interview a smaller group of applicants and would lead to lower costs and time expenditures to both applicants and programs.

While I trust that in the future, we will be able to conduct some components of the process in-person, VIs are likely here to stay. This interview cycle is an opportunity for programs to test and learn from this modality and embrace the technology. In this way, we will help transition the fellowship interview process into the 21st century and make the process easier, more affordable, and potentially even more equitable. 

References:

  1. Hariton E, Bortoletto P, Ayogu N. Residency interviews in the 21st century. J Grad Med Educ. 2016;8:322–324.
  2. Shah SK, Arora S, Skipper B, Kalishman S, Timm TC, Smith AY. Randomized evaluation of a Web based interview process for urology resident selection. J Urol. 2012;187:1380–1384.
  3. Watson SL, Hollis RH, Oladeji L, Xu S, Porterfield JR, Ponce BA. The burden of the fellowship interview process on general surgery residents and programs. J Surg Educ. 2017;74(1):167–72
  4. Edje L, Miller C, Kiefer J, Oram D. Using Skype as an alternative for residency selection interviews. J Grad Med Educ. 2013;5:503–505.
  5. Vining, C.C., Eng, O.S., Hogg, M.E. et al. Virtual Surgical Fellowship Recruitment During COVID-19 and Its Implications for Resident/Fellow Recruitment in the Future. Ann Surg Oncol (2020). https://doi.org/10.1245/s10434-020-08623-2

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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