I have a confession to make: I loved doing virtual residency interviews. I find that, if given the choice between interviewing in person or virtually, I would absolutely prefer the virtual interview. A part of me feels guilty for feeling this way, but after I reflected on how the virtual interviewing experience was for me as an underrepresented racial minority student, I realized that they were a godsend.
There were definitely challenges, but the more I think about it, the more I can’t help but feel that residency programs should consider keeping their residency interviews virtual if they are serious about their diversity, equity, and inclusion (DEI) initiatives.
The most obvious benefit of virtual interviews is the cost. There is profound socioeconomic privilege that fuels the medical education machine, and students who don’t have that privilege are more likely to be underrepresented racial minorities. They benefit the most from the relief of cost burden, myself included.
When I calculated my semester budget for my residency application fees, the numbers came back the same again and again — paying for my residency applications meant that I would fall short on my living expenses. While I was able to conjure up the funds to make the difference, I genuinely can’t fathom how I would have been able to afford in-person interviews. What would I have done if I wasn’t able to afford my travel expenses? Would I have been forced to cancel my interviews, or try to work while I was still on rotation? Just the thought of the potential cost and hypothetical fallout I would’ve had to face invokes deep anxiety. Race and socioeconomic status are tightly correlated, and I can’t help but wonder how many underrepresented minority medical students before me were disproportionately forced to make hard decisions because of the financial strain of interview season.
Cost is a compelling argument to keep virtual interviews around, but it isn’t the only factor at play. Both programs and applicants lose nuances of the in-person interview that simply cannot be replicated. At first, I thought this would be a major setback, but as I progressed through my interview season, I realized that this may actually be a good thing.
I always knew that physical appearance and clothing were implicated in an individual’s professional success, especially for women. I like to believe that physicians and physicians-to-be are beyond the internal bias instilled by intrinsically flawed social conditioning, but a 2019 Duke study that simulated the residency section process showed otherwise. Facial attractiveness and obesity status were influential in interviewers’ selections, the researchers found, and were just as influential or even more so than other academic parameters. Yes, Step 1 scores were still the best predictor of being offered an interview, but the next best predictor was “facial attractiveness.”
The 2019 Duke study on its own does not necessarily validate the merits of virtual interviews, yet I can’t help but wonder if the seemingly restricted format of a video call could help liberate the interview process of bias. Attractiveness and body habitus are dicey topics when it involves Black, Latinx, and other people of color, especially since they are typically excluded from American beauty standards and the concept of “thinness.” There is little we can do about removing bias for facial attractiveness, but the virtual format has physically narrowed the visual field of an applicant to just their shoulders and face. Some of the factors that lead to bias — clothing and weight — are literally cut out of the picture. For the sake of removing bias from our interviews and leveling the playing field for all candidates, the virtual interview has the potential to advance intersectionality in our field.
As with all things in medicine, virtual interviews have their downsides. I spoke with an attending who was the program director for a residency program in a field I did not apply to. I fished for his thoughts on how his experience of the residency application process has changed, especially regarding diversity in his program. He nodded in assent to my overall point, that the virtual interview is an overall positive development for addressing racial disparities.
But it hasn’t been easy. “The number of applications programs received has shot up this year. Our program alone received nearly 1,400 applications,” he told me. He made it a point to conduct a truly holistic review of the applications he received, which meant he didn’t use American Medical College Application Service filters to try and thin out the crowd.
“I read every single one of those applications,” he said. “But some programs just don’t have the ability to do that, even if they do holistic review, too. So they use the traditional filters, like Step 1 scores and clerkship grades, to select potential candidates.” He took a moment to let that sink in. He knew that I knew where this was going. “Which means they end up using filters that might select against underrepresented minority applicants.”
An unprecedented avalanche of applications, increased time demands for reviewers who are already impossibly busy, and compromised “holistic review” processes — these are just some of the unintended side effects of virtual residency interviews. But does that mean that the virtual interview should be shelved when in-person interviewing becomes feasible again?
“I think virtual interviews are here to stay,” the program director said. The increased applicant pool meant that he was able to increase the percentage of underrepresented minority interviewees from 20% to 30%, and he announced this with no small amount of pride. It was verbal confirmation that, while my view of virtual interviews is not entirely rosy, their problems have potential solutions.
When I left that conversation, and as I walked through convoluted hallways leading to a charting room, I couldn’t help but wonder what an applicant would gain by walking these very hallways on interview day. What would they learn about the program by seeing the attendings, the atrium, and the cafes in person? What would a program learn about me by seeing me, my body, and my clothing behind a desk instead of behind a screen?
The virtual interview is not a panacea to racial disparities in residency programs. As my attending both explained and demonstrated to me, that work falls mostly into the hands of the programs themselves. However, programs that are serious about their DEI initiatives should keep their residency interviews virtual moving forward. When it comes to the virtual interview being used as a tool for leveling the playing field for students and increasing racial equity, it appears that the benefits do indeed outweigh the risks.
Should residency interviews be in person or virtual? Share your thoughts in the comment section.
A Texas native and Massachusetts transplant, Dallas Walter is a fourth-year medical student at Tufts University School of Medicine applying into general surgery. Her personal interests include social disparities of health, diversity in medicine, and stand-up comedy. Dallas is a 2021–2022 Doximity Op-Med Fellow.
Image by venimo / Getty
