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Perception of the Virtual Interview Format in Hand Surgery Fellowship Applicants

  • Melanie Major
    Correspondence
    Corresponding author: Melanie Major, MD, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Johns Hopkins Outpatient Center 8161, Baltimore, MD 21287.
    Affiliations
    Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Outpatient Center, Baltimore, MD
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  • Joshua Yoon
    Affiliations
    Division of Plastic, Reconstructive & Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
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  • Fan Liang
    Affiliations
    Division of Plastic, Reconstructive & Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
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  • Jaimie Shores
    Affiliations
    Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Outpatient Center, Baltimore, MD
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Published:August 01, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.05.019

      Purpose

      The Coronavirus disease 2019 pandemic occurred during the interview period for numerous surgical fellowships, resulting in most programs transitioning to a virtual interview format during the 2020–2021 application cycle. This study investigated modifications adopted by fellowship programs and perceptions of the virtual interview format among hand surgery fellowship applicants.

      Methods

      Voluntary, anonymous online surveys were emailed to all applicants to the Johns Hopkins hand surgery fellowship during the 2020–2021 interview cycle. The surveys were released after the rank order list certification deadline on May 6, 2021, and closed on May 18, 2021, before the match results were released. Descriptive statistics based on the overall cohort and primary outcome of an applicant’s willingness to recommend virtual interviews in the future were conducted.

      Results

      Thirty-four of 112 (30.4%) applicants completed their surveys. Twenty-seven (79.4%) survey respondents recommended the virtual interview format in the future and 7 (20.6%) did not. Applicants who recommended virtual interviews were similar to those who did not on the basis of the number of interviews received and taken, information provided by programs, and self-rated competency with the virtual interview format. Those who recommended virtual interviews rated the effectiveness of self-advocacy higher compared with those who did not. All respondents agreed that cost savings and scheduling were more effective with virtual interviews. Perceived weaknesses differed between the 2 groups and included the lack of physical tour, difficulty with self-advocacy, and technical difficulties. The majority of survey respondents preferred in-person interviews before the interview cycle (n = 32, 94.1%), whereas nearly half of survey respondents preferred virtual interviews after the interview cycle (n = 16, 47.1%).

      Conclusions

      Nearly 80% of survey respondents recommended virtual interviews in the future. Major benefits included effectiveness of scheduling and cost savings.

      Clinical relevance

      Virtual interviews may be considered as an alternative or adjunct to in-person hand surgery fellowship interviews in the future.

      Key words

      In response to the COVID-19 pandemic, the Association of American Medical Colleges strongly encouraged teaching hospital faculty to conduct interviews by telephone or virtually for the 2020–2021 residency application cycle.
      Conducting interviews during the coronavirus pandemic. AAMC.
      In addition to local travel restrictions, residency and fellowship program directors were forced to use web- and video-based platforms to conduct applicant interviews.
      Interviews represent one of the most important aspects of the application process from the perspective of program directors and applicants in creating their rank list.
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      Qualities of residency applicants comparison of otolaryngology program criteria with applicant expectations.
      Traditionally, residency and fellowship training programs host in-person, on-site interviews to allow prospective trainees to interact with residents and staff, tour the facility, and visit the surrounding area. For these reasons, a recent survey administered to medical students and residents demonstrated that both groups favor the in-person interview format compared with the virtual interview format under normal circumstances.
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      Perception of medical students and residents about virtual interviews for residency applications in the United States.
      In particular, trainees have expressed concern that virtual interviews do not facilitate an accurate representation of themselves compared with in-person interviews.
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      Planning virtual residency interviews as a result of COVID-19: insight from residency applicants and physicians conducting interviews.
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      Virtual interviews at Graduate Medical Education Training Programs: determining evidence-based best practices.
      Before this application cycle, a limited number of graduate medical education residency and fellowship programs had published their experience with the virtual interview format.
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      • Healy W.L.
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      For urology residency applicants, a single-site cross-sectional study demonstrated that applicants perceived web-based interviews as less effective than traditional on-site interviews.
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      However, an adult orthopedic reconstruction fellowship program reported that 85% of survey respondents believed that videoconference interviews provided a satisfactory understanding of the fellowship program.
      • Healy W.L.
      • Bedair H.
      Videoconference interviews for an adult reconstruction fellowship: lessons learned.
      Given the conflicting existing literature regarding the efficacy of virtual interviews from the applicant’s perspective, additional research is needed to understand their role in the hand surgery fellowship application process.
      The purpose of this study was to understand the modifications adopted by fellowship programs, identify perceived strengths and weaknesses of the virtual interview format during the 2020–2021 hand surgery fellowship application cycle, and compare differences between those who would recommend the virtual interview platform to prospective applicants with those who would not. We hypothesized that applicants who are willing to recommend virtual interviews in the future would differ in their perceptions of the strengths and weaknesses of the virtual format compared with those who did not.

      Materials and Methods

      All 112 applicants to the Johns Hopkins hand surgery fellowship were identified and invited to participate in a survey regarding their perspectives on the virtual interview format using Qualtrics software. The study was reviewed and exempted from the university’s institutional review board. The survey was distributed via email on May 6, 2021 after the rank order list certification deadline. A reminder email was sent on May 17, 2021, and the survey closed on May 18, 2021, the day before match results were released. These dates were chosen to minimize bias related to rank list creation and match results. The full-length survey is available in Appendix 1 (available online on the Journal's website at www.jhandsurg.org).
      The survey gathered information on applicant demographics including how many programs applicants applied to, the number of interviews they received and attended, and the format of those interviews. Applicants were asked to rate their competence with virtual video communication platforms and how program information was distributed before the interview date. Information was gathered on virtual interview logistics including the number of interviews at each program, days of the week they occurred, and the virtual platform used most frequently. Information about the interview experience was gathered through questions about any technical difficulties that were encountered, including video issues, audio issues, difficulty navigating the platform, connection issues, and scheduling issues. Survey respondents were asked to rate the perceived detriment of not being able to meet residents/fellows and support staff, not being able to tour the facilities physically, and not being able to see the surrounding area. Applicants were asked questions regarding the perceived effectiveness of certain elements of the virtual interview process, as well as its perceived strengths and weaknesses compared with an in-person interview process. Finally, applicants were asked about their preferred interview format before and after the interview cycle and whether they would recommend virtual interviews for future application cycles. Open text questions related to strengths, weaknesses, and recommended formats also were included.
      Descriptive statistics were conducted including mean, median, and interquartile range for continuous variables and percentages were used to summarize categorical variables with respect to the overall cohort and the primary outcome.

      Results

      Demographic data

      Of the 112 applicants emailed, 34 (30.4%) completed the survey. Summary statistics for all survey questions are presented in Tables 1 and 2 for continuous and categorical variables, respectively. Applicants reported applying to a mean of 41.8 programs, receiving a mean of 19.4 interviews, and completing a mean of 17.6 interviews, nearly all of which were virtual. The majority of applicants attended medical school in coastal cities (n = 24, 70.6%) compared with Midwest and international cities. Over 85% of applicants reported interviewing at multiple programs in a single day. Additionally, 15 (44.1%) of survey respondents reported interviewing at programs they were not considering seriously, of which 4 (26.7%) indicated using those interviews as practice.
      Table 1Summary Statistics for Applicants for Continuous Variables (n = 34)
      VariableMean ± SDMedian (Q1, Q3)Min, Max
      No. of programs applied41.76 ± 16.6139.5 (30, 50)12, 100
      No. of interviews offered19.41 ± 8.3418.5 (12.25, 25)6, 39
      No. of interviews taken17.62 ± 6.6719 (12.25, 22.75)5, 34
      No.of virtual interviews17.38 ± 7.0718.5 (12.25, 22.75)0, 34
      Money spent during cycle747.35 ± 787.71390 (100, 1275)0, 3000
      Percentage of programs with a centralized meeting space77.62 ± 24.8083 (70, 100)17, 100
      Percentage of programs with a virtual tour35.94 ± 24.7030 (17.5, 50)5, 100
      Percentage of programs that provided virtual information before interview day60.59 ± 24.5354 (42, 77.75)20, 100
      Percentage of programs that provided physical information/ material before interview day23.03 ± 17.9520 (11, 25)1, 80
      Percentage of programs that provided any information session during the interview day83.44 ± 19.2285.5 (75, 100)30, 100
      Expectation of cost for in-person interview cycle6097.06 ± 3357.805000 (3250, 9750)0, 12000
      Table 2Summary Statistics of Applicants for Categorical Variables
      VariableTotal (%) n = 34
      Location of medical school by region
       Coastal cities (east and west)24 (70.59)
       Midwest and outside of United States10 (29.41)
      Interviewed at programs they were not seriously considering
       No19 (55.88)
       Yes15 (44.12)
      Reason for interviewing at programs not seriously considered
       No disadvantage in taking more7 (46.67)
       Additional practice4 (26.67)
       Other reason4 (26.67)
       Total
      Competence navigating virtual communication platforms before interview season
       Below average2 (5.89)
       Average18 (52.94)
       Above average14 (41.18)
      Average number of dates available to schedule an interview
       11 (2.94)
       221 (61.76)
       310 (29.41)
       ≥42 (5.88)
      Average number of days the interview was conducted
       118 (52.94)
       210 (29.41)
       35 (14.71)
       ≥41 (2.94)
      Average number of interviews per program
      Denotes question in which total n = 33 due to a missing response.
       11 (3.03)
       20
       35 (15.15)
       ≥427 (81.82)
      Part of the week most interviews occurred
       Weekday4 (11.76)
       Weekend10 (29.41)
       Equal20 (58.82)
      Most frequent interview structure
       Single interviewer per interview21 (61.76)
       Multiple interviewers per interview13 (38.24)
      Most effective interview structure
       Single interviewer per interview22 (64.71)
       Multiple interviewers per interview12 (35.29)
      Interviewed at multiple programs in a single day
       No15 (44.12)
       Yes19 (55.88)
      Clinical patient images shown during virtual interview
       No11 (32.35)
       Yes23 (67.65)
      Disclaimers made to protect patient privacy if patient images were shown
       No7 (30.43)
       Yes16 (69.57)
      Most frequently required interview attire
       Business11 (32.35)
       Business casual0
       Did not specify23 (67.65)
      Types of technical issues encountered
       No issues3 (8.82)
       Connection20 (58.82)
       Platform navigation6 (17.65)
       Video18 (52.94)
       Audio16 (47.06)
       Scheduling10 (29.41)
       Other3 (8.82)
      Amount of technical difficulty experienced
       None3 (8.82)
       A little bit30 (88.24)
       A moderate amount1 (2.94)
       A great deal0
       Where were interviews conducted
      Denotes question in which total n = 33 due to a missing response.
       Home26 (78.79)
       Hospital5 (15.15)
       Other2 (6.06)
      Detriment of not being able to meet residents/ fellows and support staff
       No detriment0
       A little bit11 (32.35)
       A moderate amount15 (44.12)
       A great deal8 (23.53)
      Detriment of not having a physical tour
       No detriment6 (17.65)
       A little bit16 (47.06)
       A moderate amount5 (14.71)
       A great deal7 (20.59)
      Detriment of not seeing the surrounding area
       No detriment1 (2.94)
       A little bit22 (64.71)
       A moderate amount6 (17.65)
       A great deal5 (14.71)
      Effectiveness at advocating/ conveying yourself virtually compared with in-person
       Significantly less effective0
       Less effective13 (38.24)
       No difference10 (29.41)
       More effective10 (29.41)
       Significantly more effective1 (2.94)
      Effectiveness of cost savings virtually compared with in-person
       Significantly less effective0
       Less effective0
       No difference0
       More effective2 (5.88)
       Significantly more effective32 (94.12)
      Effectiveness of scheduling virtually compared with in-person
       Significantly less effective0
       Less effective0
       No difference0
       More effective10 (29.41)
       Significantly more effective24 (70.59)
      Effectiveness of learning about program virtually compared with in-person
       Significantly less effective0
       Less effective21 (61.76)
       No difference7 (20.59)
       More effective6 (17.65)
       Significantly more effective0
      Effectiveness of learning about surrounding area virtually compared with in-person
       Significantly less effective10 (29.41)
       Less effective18 (52.94)
       No difference6 (17.65)
       More effective0
       Significantly more effective0
      Effectiveness of meeting current residents/ fellows virtually compared with in-person
       Significantly less effective5 (14.71)
       Less effective22 (64.71)
       No difference4 (11.76)
       More effective3 (8.82)
       Significantly more effective0
      Effectiveness overall of virtual format compared with in-person
       Significantly less effective0
       Less effective11 (32.35)
       No difference11 (32.35)
       More effective12 (35.29)
       Significantly more effective0
      Strengths of virtual interview
       Ability to participate in more interviews29 (85.29)
       Less formal5 (14.71)
       Ease of scheduling30 (88.24)
       Cost34 (100)
       Other1 (2.94)
      Weakness of virtual interview
       Lack of physical tour13 (38.24)
       Difficult to advocate self or convey things effectively13 (38.24)
       Less intimate/ personal29 (85.29)
       Technical difficulties16 (47.06)
       Other4 (11.76)
      Preferred interview format before interview season
       In-person32 (94.12)
       Virtual1 (2.94)
       Other1 (2.94)
      Preferred interview format after interview season
       In-person15 (44.12)
       Virtual16 (47.06)
       Other3 (8.82)
      Denotes question in which total n = 33 due to a missing response.

      Perceived strengths and weaknesses of the virtual interview platform for all respondents

      When querying all survey respondents, the majority preferred in-person interviews before the interview cycle (n = 32, 94.1%), whereas nearly half of survey respondents preferred virtual interviews after the interview cycle (n = 16, 47.1%). In terms of strengths of the virtual interview, 34 (100%) of respondents selected cost, 30 (88.2%) selected ease of scheduling, and 29 (85.3%) selected ability to participate in more interviews. In terms of weaknesses of the virtual interview, 29 (85.3%) of respondents selected less intimate/personal, 16 (47.1%) selected technical difficulties, and 13 (38.2%) of respondents selected a lack of physical tour and difficulty with self-advocacy. No survey respondent felt that the virtual interview format was more effective than in-person interviews in learning about the surrounding area. On average, survey respondents expected to pay over $6,000 for the in-person interview cycle, but reported actually spending $747.35 during the virtual cycle.

      Modifications adopted by hand surgery fellowship programs

      From the program perspective, 33 (97.1%) of programs had ≥2 dates available to schedule an interview. The most frequent interview structure was a single interviewer (n = 21, 61.8% of respondents) and the majority of respondents (n = 22, 64.7%) felt the single interviewer structure was most effective. On the day of the interview, only 35.9% of programs provided a virtual tour and 83.4% of programs provided an information session.

      Grouped analysis based on primary outcome

      Twenty-seven (79.4%) survey respondents recommended the virtual interview format for prospective applicants and 7 (20.6%) did not. These 2 groups were similar based on the number of interviews received and taken, information provided by programs, and self-rated competency with the virtual interview format. Those who recommended virtual interviews in the future rated the detriment of not being able to meet residents/fellows and support staff lower compared with those unwilling to recommend virtual interviews. Those unwilling to recommend virtual interviews rated the effectiveness of advocating/conveying themselves virtually lower compared with the willing to recommend group. The perceived weakness of the virtual interview format varied between the 2 groups with those not willing to recommend virtual interviews most commonly rating a lack of a physical tour and difficulty in advocating for themselves as weaknesses, whereas technical difficulties were the most cited weakness among those who did recommend the virtual interview format in the future (Table 3).
      Table 3Summary Statistics by Applications Who Would Recommend Virtual Interviews
      VariableNo

      N = 7
      Yes

      N = 27
      Types of technical issues encountered
       No issues1 (14.29)2 (7.41)
       Connection2 (28.57)18 (66.67)
       Platform navigation3 (42.86)3 (11.11)
       Video5 (71.43)13 (48.15)
       Audio4 (57.14)12 (44.44)
       Scheduling3 (42.86)7 (25.93)
       Other03 (11.11)
      Detriment of not being able to meet residents/fellows and support staff
       No detriment00
       A little bit011 (40.74)
       A moderate amount6 (85.71)9 (33.33)
       A great deal1 (14.29)7 (25.93)
      Effectiveness at advocating/conveying yourself virtually compared with in-person
       Significantly less effective00
       Less effective5 (71.43)8 (29.63)
       No difference2 (28.57)8 (29.63)
       More effective010 (37.04)
       Significantly more effective01 (3.70)
      Effectiveness overall of virtual format compared with in-person
       Significantly less effective00
       Less effective4 (57.14)7 (25.93)
       No difference2 (28.57)9 (3.70)
       More effective1 (14.29)11 (40.74)
       Significantly more effective00
      Weaknesses of virtual interview
       Lack of physical tour6 (85.71)7 (25.93)
       Difficult to advocate self or convey things effectively6 (85.71)7 (25.93)
       Less intimate/personal6 (85.71)23 (85.19)
       Technical difficulties4 (57.14)26 (96.30)
       Other04 (14.81)
      Preferred interview format after interview season
       In-person6 (85.71)9 (33.33)
       Virtual1 (14.29)15 (55.56)
       Other03 (11.11)

      Other

      Free responses regarding ways to change the virtual interviews in the future were mixed but most felt more information about the program and surrounding city as well as smaller group question sessions would have improved the experience. When asked in a free response question what the most important factors are when forming a rank list, 8 of the 34 (23.5%) survey respondents listed “fit” as the most important factor.
      Technical issues were common, with 30 (88.2%) of the respondents stating that they experienced a small degree of technical difficulty during the interview process. The top 3 technical issues encountered by applicants included connection issues (n = 20, 58.8%), video issues (n = 18, 52.9%), and audio issues (n = 16, 47.1%).

      Discussion

      This study evaluated the perception of virtual hand surgery fellowship interviews among applicants during the COVID-19 pandemic. While 94.1% of applicants preferred the in-person interview process before the interview cycle, 44.1% preferred the in-person interview after the interview cycle. With further optimization, virtual interviews may become a mainstay in the surgical fellowship interview process.
      The increased flexibility of virtual interviews has highlighted an issue many programs were facing before the pandemic; that is, the number of applicants has continued to increase despite a limited number of interview spots. According to our survey, the average number of interviews offered and accepted by survey respondents were 19.4 and 17.6, respectively. While the number of interviews offered is consistent with previous literature, the number of interviews taken by our survey respondents is higher than reported previously.
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      The hand surgery fellowship application process: expectations, logistics, and costs.
      A study from 2015 found that the majority of hand fellowship applicants accepted 12 interviews and often had to cancel an interview because of another interview conflict.
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      The hand surgery fellowship application process: expectations, logistics, and costs.
      Previous studies have demonstrated that competitive applicants hoard interviews, using some as practice.
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      Our survey respondents unanimously rated virtual interviews as more effective based on ease of scheduling and allowed 19 (55.9%) of survey respondents to attend >1 program interview in a day. Nearly half of our survey respondents endorsed interviewing at programs they were not considering seriously, of which over a quarter reported using those interviews as practice. The virtual interview platform may worsen interview hoarding by competitive applicants by decreasing financial and scheduling constraints. Several groups have suggested ideas to decrease the practice of interview hoarding, including encouraging programs to open more interview slots and capping the number of programs an applicant can apply to and attend.
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      Further research is likely needed to better understand how to create a fair and diverse applicant pool.
      When stratifying survey respondent results based on their willingness to recommend virtual interviews in the future, we found similarities between the groups based on demographic information or interview logistics, and differences in the perceived strengths and weaknesses of the virtual interview process. The perceived effectiveness of virtual interviews in advocating and conveying oneself was lower in the group unwilling to recommend virtual interviews. This is consistent with the literature demonstrating trainee concerns about conveying themselves virtually.
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      Key insights from the development and implementation of a novel virtual interview process for medical school admissions during the COVID-19 pandemic [Epub ahead of print].
      In addition, the unwilling to recommend group rated virtual interviews as having a greater detriment on being able to meet a program’s residents and fellows. Finally, there were differences in perceived weaknesses between the 2 groups; a lack of tour and difficulty with self-advocacy were rated as weaknesses more often in the unwilling to recommend group, whereas those willing to recommend virtual interviews cited technical difficulties as a weakness more often. Perceiving lack of a tour and difficulties with advocating for oneself as a weakness may speak to applicants’ desire to find a professional and social fit at a program. Although “fit” remains a poorly defined term, previous studies have associated happiness, program collegiality, and faculty relationships with the term and may represent areas that are particularly difficult to assess in a virtual interview process.
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      Cost savings was a perceived strength of the virtual interview process across all survey respondents. Before the COVID-19 pandemic, the economic and clinical burden associated with the surgical fellowship interview process was being examined. In 2014, a survey of 129 orthopedic surgery residents demonstrated an average cost of $5,875 for travel and 11 missed residency training days to attend fellowship interviews.
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      Similarly, in 2017 a survey of general surgery fellowship applicants demonstrated that 57.7% of residents missed ≥7 days of clinical training to attend interviews, 62.3% spent over $4,000 on the interview process, and 57.3% of residents were in favor of change in the interview process.
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      Consistent with other groups that have published on the benefits of virtual interviews, we found candidates spent on average $747 for the entirety of the virtual interview cycle, lower than the average in-person costs reported in the literature.
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      The perceived weaknesses associated with the virtual interview may be tempered by their cost savings and ability to reduce disruption to applicants’ clinical duties.
      There were several limitations to this current study, including its single-site nature, although applicants to the Johns Hopkins hand surgery fellowship program were professionally and geographically diverse. With a response rate of 30.4%, most participants in the interview cycle were not captured in our survey results, which introduces concerns regarding response bias and the overall generalizability of findings. Additionally, this study may be limited by recall bias because survey respondents had just completed virtual interviews and their in-person interview experiences were likely more remote. However, the logistical constraints created by the COVID-19 pandemic created a situation in which virtual and in-person interviews could not be compared more directly. Finally, this survey was sent intentionally to applicants after the rank order list certification deadline and closed before match day to minimize bias related to match results. Therefore, this study does not capture perceptions of the virtual interview format based on match results of applicants. It is possible that perceptions would change based on match outcomes.
      While COVID-19 travel restrictions have lifted gradually, the pandemic forced a radical change in the graduate medical education residency and fellowship interview process. It is unclear whether interviews in upcoming application cycles will be in-person or virtual, but one alternative is a hybrid approach. Based on the findings of a survey sent to maternal fetal medicine applicants, 58.7% preferred a hybrid approach combining in-person with virtual interviewing.
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      Similarly, a survey sent to medical student applicants revealed that 71% of them believed that virtual interviews should be an option for future applicants.
      • Garden E.
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      • Sanky C.
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      The results of this study may be used to further strengthen the role of virtual interviews as an adjunct or alternative to in-person interviews, particularly with optimizing the interviewee’s experience to help identify fit, improve virtual tours, and allow candidates to advocate for themselves. Mailing brochures and program information before the interview day, creating digital content for applicants to view during interviews, and increasing the amount of time current fellows and residents spend interacting with prospective applicants are the possible first steps to addressing applicant concerns about virtual interviews and optimizing the process for future years.

      Supplementary Data

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