How Virtual Residency Applications Impact Diversity Initiatives

In an opinion piece published in the July 2021 issue of Neurology, the medical journal of the American Academy of Neurology, Joshua Budhu, MD and Justin Jordan, MD, MPH, discuss the implications of virtual residency applications and interviews to amplify diversity and inclusion among neurology residency programs. In this Q&A, the authors elaborate on the opportunities and challenges that a virtual setting presents for both the applicants and residency programs.

Q: What led you to dive deeper into the opportunities or challenges that the residency virtual interviewing process presents? 

Josh: It was during my third year of medical school that I decided I wanted to pursue a career in neurology. Unfortunately, my medical school did not have a neurology department or residency and encouraged me to seek external mentorship and opportunities. As a result, I participated in the Visiting Clerkship Program at Harvard Medical School. This experience was transformative and the reason why I came to the Mass General Brigham neurology residency and subsequently stayed for fellowship. During my application season, mentors from the program and the Center for Diversity and Inclusion (CDI) engaged with me and actively followed my progress. I still vividly remember my CDI applicant reception and having the opportunity to meet the president of MGH and ask candid questions about diversity and inclusion. 

This commitment to diversity, inclusion, and equity had a lasting impression on me and I sought to pay it forward as a resident. I actively participated in CDI recruitment efforts and neurology specific recruitment, especially during my time as chief resident.

When it was announced that the 2020-2021 season would be virtual, I immediately thought of all the recruitment efforts that I had directly benefited from, and how they would have to change; including away rotations, the Harvard Affiliated Residency Programs Showcase, CDI and residency specific efforts. I also realized the bias that could be introduced virtually and how it could disadvantage students who are underrepresented in medicine (UIM). My co-authors and I worked to identify the unique challenges that a virtual application season presents, including bias during the virtual interview, expected increase in residency applications leading to candidates between screened out based on outdated metrics, and the reworking of traditional recruitment efforts geared towards UIM applicants. We also found many opportunities for increasing diversity during virtual or hybrid recruiting, including the opportunity to standardize interviews, decreased residency application costs, and the ability to revamp the application screening process. Virtual interviewing and applications have the ability to exacerbate disparities in medicine, but if used correctly can become a powerful tool in attaining equity.

Q: As part of the neuro-oncology fellowship interviewing committee, what challenges did you face when the transition was made? 

Justin: Authenticity is the most important part of interviews and is also the toughest aspect to achieve virtually. Both the training program and the applicant must work hard to provide more than an application packet and a cinematic façade. To help overcome this challenge in part, some programs (including ours) provide dedicated time for social interactions online between applicants and current trainees, in addition to virtual interviews. We also have interviewees meet with two faculty members at once over the course of multiple interviews, in hopes of showing inter-relational dynamics and maximizing the number of faculty met. Finally, we highlight both the many positive aspects of our program, as well as some of the feedback we hear from current and prior trainees, toward a goal of a maximally informed interview experience.

Q: Did you find it cumbersome to make a connection with the interviewee, and why? 

Justin: Relationships can be more difficult to forge with virtual interviews, but one can still make a meaningful connection with effort. In addition to a thorough review of all application materials, I like to relate to applicants by exploring the content of their submitted personal statement. I also like to explore their experience with our field, and/or career goals. However, I recognize there is risk of unconscious bias in our interactions, and I try to mitigate that risk as much as possible in steering our conversation.

Q: Could virtual interviews present an opportunity for candidates that otherwise would have a financial burden to interview in person? 

Josh: Unequivocally yes. As we mentioned in the article, most fourth year medical students spend between $1,000 and $5,000 on residency interviews. This cost disproportionately affects applicants who are UIM; they are more likely to carry student debt and less likely to have the financial security such as family support to help offset costs. When I was in medical school I lived “student loan check” to “student loan check”, which affected my choices on where to apply and interview for residency. The opportunity for virtual interviews can help to alleviate the financial stressors of the interview process, allowing more opportunities for candidates all across the board.

Q: What can faculty and interviewing committees do to promote an equitable and inclusive virtual atmosphere? 

Justin: We highlight in our article a variety of opportunities for virtual residency recruitment, with targeted efforts toward UIM populations. In an era of virtual interview optionality, there may also be more applications, and so we suggest a change to application screening in order to reduce bias. Finally, interviewers should receive unconscious bias training, and programs should ensure that ranking and scoring of applicants is not impacted by in-person vs remote interviews, or for technological challenges (internet speed, virtual background, etc.), which may introduce variation into interview experiences.

Q: Did you find social media to be a helpful element in this somewhat different season? In what way can applicants use it in their favor?

Josh: Social media played a large role during the virtual application season. Normally, interview days include tours, site visits, and the ability to glean some of the more intangible aspects of a residency program. Instead, most applicants had to choose a residency program without actually having physically visited the hospital or campus. Social media was able to partially fill that void by allowing residency programs to showcase current residents, residency experiences, commitment to education and outreach. Groups such as the #NeuroTwitterNetwork allowed residency programs, faculty, and residents to connect directly with applicants. Additionally, social media events such as webinars, “ask me anything” events, trainee trivia and combined events focused on the application process helped to expand the reach of programs while also promoting interinstitutional collaboration. Social media outreach helped to provide applicants with additional information to navigate this application season and efforts should continue in both hybrid and traditional application seasons.

Q: Any final takeaways?

Justin: The overarching theme is that a diverse and inclusive neurology workforce is vital to providing the best care for patients. The COVID-19 pandemic forced residency programs to create virtual pathways for recruitment and interviews, and we feel that there is opportunity to capitalize on this change. We hope that the challenges we highlight, and recommendations we provide, will aid programs in their efforts to recruit and hire the most diverse and inclusive generation of neurologists yet.