Obstetrics and gynecology fellowship interview preferences

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Authors:

Emily P. Barnard, D.O., Jenifer N. Byrnes, D.O., John A. Occhino, M.D.

Department of Obstetrics and Gynecology, Mayo Clinic

Abbreviations

ACGME, Accreditation Council for Graduate Medical Education

FPMRS, female pelvic medicine and reconstructive surgery

MFM, maternal-fetal medicine

NRMP, National Resident Matching Program

REI, Reproductive Endocrinology and Infertility

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Introduction

Applying to a subspecialty fellowship program in obstetrics and gynecology is increasingly competitive as the number of applicants steadily increases. Data from the National Resident Matching Program (NRMP) indicate that 464 applicants certified a rank order list in 2016, compared to 430 in 2015. Specialties included were gynecologic oncology, minimally invasive gynecologic surgery, pediatric and adolescent gynecology, reproductive endocrinology and infertility (REI), maternal-fetal medicine (MFM), and female pelvic medicine and reconstructive surgery (FPMRS).1 Two-thirds of applicants (63.6%) were matched with their chosen subspecialty, and 94.6% of programs were filled.

A survey of subspecialty fellows in 2014 showed that 51.5% of the 169 respondents spent at least 10 days away from their residency program for interviewing. For the resident, this time commitment creates challenges related to coordinating travel arrangements and scheduling rotations and clinical responsibilities. Applicants are pressured to apply to several programs and attend as many interviews as possible, because compared to candidates who are not matched to a program, successfully matched candidates apply to more programs, receive more invitations to interview, and attend more interviews.2

A recent call to action proposed several changes to streamline the interview process.3 The main concern was that excessive time away from work detracted from clinical duties. In addition, the lack of coordination between regional programs for facilitating travel arrangements increases the cost of travel and fatigue related to multiple trips and different time zones. Overlapping dates may force residents to cancel an interview affecting both the applicant’s chances to be selected for a program and the program coordinators’ planning for the interview day. This movement to improve the fellowship interview process has gained traction in the field of Gynecologic Oncology and REI, with changes planned to address some of these concerns.

While many of the shortcomings of the interview process are known, little is known from the applicant’s perspective. We aimed to collect demographic and preference data from obstetrics and gynecology residents applying for subspecialty fellowships in 2016.

Materials and Methods

Our survey was designed with a web-based tool (SurveyMonkey; http://www.surveymonkey.com) (Figure 1). A link to the survey was sent to all residency program directors for distribution to fourth-year residents in obstetrics and gynecology residency programs in the United States accredited by the Accreditation Council for Graduate Medical Education (ACGME). Program director names and email addresses were gathered from FREIDA Online, the American Medical Association Residency and Fellowship Database that allows individuals to search for all programs accredited by the ACGME. Persons with limited English proficiency were excluded because the survey was distributed in English through an email link. This study was approved by the institutional review board at Mayo Clinic in Rochester, MN.

The survey became available September 1, 2016, and an email link was sent to all program directors for distribution on that date. A reminder email was sent to program directors on September 15, 2016, to encourage participation. The last day the survey was available was October 1, 2016; match day was October 5.

Respondents were asked whether they applied to a fellowship program for the 2016 application cycle. If an individual did not apply to fellowship in 2016, the survey concluded. Those who did apply were directed to complete the survey and provide demographic information, including age, gender, race, and family status. The survey gathered information on the size and location of their residency program, whether others in their class were applying to a fellowship program, to which subspecialty fellowship the applicant was applying, the number of interview invitations the applicant received, and the number of interviews the applicant attended. Applicants were asked about which days of the week were best for interviews, about the timing of interviews, about web-based interview alternatives, and about the cost to attend each interview. Descriptive statistics were used to evaluate survey responses.

Results

A total of 192 fourth-year residents completed the survey, and 140 respondents (72.9%) applied to a subspecialty fellowship program in 2016. Approximately 1,255 obstetrics and gynecology residents matriculate each year, so we estimate that our survey captured data from 15.3% of all fourth-year trainees. Of those who answered the specific questions, 73.8% were female (96 of 130) and 78.5% (102 of 130) were white. The majority were married or in a committed relationship (100 of 130; 76.9%), but most did not have children (97 of 130; 74.6%) (Table 1).


More applicants described the setting of their training program as “academic” (105 of 129; 81.4%) rather than “community” (24 of 129; 18.6%). Mean residency class number for those applying to fellowship was 7.5 per year. The structure of on-call duties during interview months varied by institution and the trainee’s rotation. The various types of reported on-call duties included night float (58 of 129; 45.0%), 24-hour in-house on-call shifts (77 of 129; 59.7%), and home call (19 of 129; 14.7%). Of those applying for a fellowship program, 88.3% (113 of 128) had classmates who were also participating in the match process. Those in a community program were significantly less likely to have co-residents applying to a fellowship program than those in an academic setting (66.7% vs 93.3%, P<.001). Information on specific programs represented was not obtained in order to keep responses anonymous and encourage participation.

Fellowship applications were distributed throughout the disciplines (Figure 2). The largest number of respondents applied to an MFM program (45 of 127; 35.4%). NRMP data indicated that this specialty had the largest applicant pool, with 155 applicants certifying a rank list in 2016, so our survey captured data for 29.0% of residents applying to an MFM program. The highest percentage of applicants was for REI, where 36% of the 75 who ranked this specialty participated in our survey. Only 4 respondents applied to fellowships outside the traditional match, including breast surgery (n=1), palliative care (n=1), reproductive infectious disease (n=1), and unspecified (n=1).

Figure 2. To Which Fellowship Did You Apply? Fellowship applicants’ responses to this survey question are shown. FPMRS indicates female pelvic medicine and reconstructive surgery; GynO, gynecologic oncology; MFM, maternal-fetal medicine; MIGS, minimally invasive gynecologic surgery; Peds gyn, pediatric gynecology; REI, reproductive endocrinology and infertility.

Time allotted away from residency was variable (Figure 3): Of 125 residents who answered the question, 84% were allowed personal days to interview, ranging from 1 to 3 days (n=6; 4.8%) to 11 or more days (n=31; 24.8%). The largest percentage of applicants were allowed 6 to 10 personal days for interviews (n=46; 36.8%). Vacation time was used for interviews by 56.8% of applicants (71 of 125), and 8.9% (11 of 123) were not receiving pay while they attended their interviews.


Figure 3. How Many Personal Days Does Your Program Provide for Interviewing? Fellowship applicants’ responses to this survey question are shown.

Applicants received invitations to an average of 15.1 interviews and attended a mean of 10.9 interviews across all disciplines. Applicants to FPMRS programs attended the largest mean number of interviews (12.8), while applicants to MFM programs attended the smallest mean number of interviews (9.8).

Of the 85 applicants who answered the question, 68% canceled at least 1 interview (Table 2). The most common reason for canceling was conflict with another interview (n=61; 71.8%). About half the residents who canceled interviews did so for financial (n=44; 51.8%) or work-related reasons (eg, on-call obligations [n=43; 50.6%]). A novel web-based video conferencing interview format was offered by some programs in 2016, with 14 residents being offered this opportunity and 7 participating in this format.

When preferences for interview dates and timing were collected from respondents, the largest percentage indicated that Saturday interviews were preferred (n=51; 47.2%); the least preferred day to interview was Wednesday. Half-day interviews were overwhelmingly preferred (n=111; 93.3%) to full-day interviews. Most thought that starting an interview at 8 AM was optimal (n=72; 60.5%), with few applicants preferring to start an interview in the afternoon (n=3; 2.5%). A pre-interview dinner was a favorable attribute for 64.7% of respondents. Those who did not prefer the dinner most commonly reported travel-related reasons (n=36; 85.7%).

About half the respondents were aware of grouping interview dates geographically, and 49.6% (59 of 119) reported that they did use regional coordination when scheduling interviews. The average cost per interview, inclusive of airfare, lodging, ground transportation, food, and clothing, was $859.50. With applicants attending an average of 10.9 interviews, the total cost of the process, not including application fees, averaged $9,368.55.

Discussion

Respondents to our survey confirmed that the subspecialty fellowship interview process is challenging, creating scheduling difficulties with co-residents and financial strain on families. Additional financial strain may arise when residents use vacation time or do not receive pay while they attend interviews. Many programs do not limit the number of interviews that residents may attend, so the only limitations would be budgetary or other concerns on the part of the applicant. Both time away from work and financial concerns may cause candidates to attend fewer interviews. Previous studies have shown that attending more interviews increases the chances of matching with a fellowship program,4 so more restrictive residencies may be limiting the opportunities for their residents to match into a competitive fellowship program.

The NRMP data suggest that 464 residents applied to subspecialty fellowship in 2016, including both the FPMRS August match and the traditional October match. A total of 140 applicants responded to our survey, for a response rate of 30.2%. Our target for the survey was fourth-year residents in ACGME-accredited programs in the United States. Nontraditional applicants applying to fellowship after working or participating in research or other clinical fellowship programs did not have access to this survey. One limitation in our study is that the NRMP does not distinguish between applicants in their fourth year of training and those already in practice; therefore, our response rate appeared lower overall but may have been more favorable if we consider that it captured data only from applicants still in residency training. NRMP does stratify match rates based on applicant medical school (i.e. US graduate, foreign medical graduate, or osteopathic medical school graduate); this data was not collected in our survey but should be considered in future research.

The process of interviewing for fellowship positions may change in the future. The Committee on Fellowship Training in Obstetrics and Gynecology was established in 2011.3 Potential solutions to some of the scheduling complications included allotting specific weeks or months to each subspecialty so that residents could anticipate absences. Web-based interviewing with tools such as Skype (Microsoft) was also piloted by some programs in 2016. Previous studies in other disciplines have shown that candidates prefer in-person interviews to gain a more personal perception of the program,5 so it is uncertain whether these new strategies will become popular. Other proposed changes include conducting preliminary interviews at subspecialty meetings to help decrease the number of in-person interviews.6

Our survey results show multiple areas for improvement in the interview process. Only 47.1% of applicants could schedule interviews with regional coordination. This cross-country travel leads to increased time away from residency obligations and family and fatigues the applicant, both during the interview and at work. Use of vacation days for interviewing means that residents who already have challenging work schedules have less vacation time to relax. Chief residents have multiple administrative, clinical, and educational duties, and completing those tasks in addition to interviewing for competitive fellowships can lead to burnout and interfere with their wellness. Also, the inefficiencies of the interview process contribute to the financial burden placed on trainees: In our study, the average total cost for interviewing exceeded $9,000.

Conclusions

Interviewing for a fellowship program is an expensive, time-consuming process for applicants that often inconveniences their co-residents and creates scheduling challenges for program directors. According to applicant preferences, the process could be improved by implementing regional coordination between neighboring programs, condensing interview days, and offering weekend interview dates.

Based on the results of this survey, we applaud the changes being made across fellowship disciplines, most recently in REI. These improvements should be instituted as permanent to streamline the process for both programs and applicants. A shared calendar with regional interview date coordination by neighboring programs will help to decrease cost and time away from work for future fellows. A common date for notification of interview invitations would allow applicants to schedule their travel further in advance, both cutting costs and easing scheduling with their co-residents. Gathering additional information from both applicants and fellowship directors will further streamline the fellowship interview process.  

References

1.      National Resident Matching Program. Results and Data: Specialties Matching Service 2017 Appointment Year. National Resident Matching Program, Washington, DC. 2017.

2.      Iqbal IJ, Sareen P, Shoup B, Muffly T. Attributes of successfully matched versus unmatched obstetrics and gynecology fellowship applicants. Am J Obstet Gynecol. 2014;210:567 e561-568.

3.      Frishman GN, Bell CL, Botros S, et al. Applying to subspecialty fellowship: clarifying the confusion and conflicts! Am J Obstet Gynecol. 2016;214:243-246.

4.      Chun R, Preciado D, Brown DJ, et al. Choosing a fellow or fellowship: a survey of pediatric otolaryngologists. JAMA Otolaryngol Head Neck Surg. 2014;140:102-105.

5.      Deloney LA, Perrot LJ, Lensing SY, Jambhekar K. Radiology resident recruitment: A study of the impact of web-based information and interview day activities. Acad Radiol. 2014;21:931-937.

6.      Gressel GM, Van Arsdale A, Dioun SM, Goldberg GL, Nevadunsky NS. The gynecologic oncology fellowship interview process: Challenges and potential areas for improvement. Gynecol Oncol Rep. 2017;20:115-120.


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2 Comments

Go to the profile of Luis Hoyos
Luis Hoyos 9 days ago

I agree with the authors that the interview process for fellowship is a challenging one and that it imposes a financial burden on the applicant. In my opinion it is very important for the home program to support their residents since their success highly depends on the number of interviews they attend as shown by data. However, I understand their difficulties in doing so, therefore, anything that the fellowship match per se can do to streamline and make the application process easier is welcomed. Same day of notification, regional coordination and the option of an online interview if needed are steps in the right direction but I do think that there is much more gain and understanding of applicants as well as programs when the interview is done in person. Congratulations to the authors! 

Go to the profile of M. Blake Evans
M. Blake Evans 5 days ago

Fantastic study that surfaces many concerns that fellowship applicants have. Regional coordination amongst programs would have saved me multiple flights, avoided interview cancellations due to schedule conflicts, and time away from a busy residency. I applaud the authors for voicing a much needed change!