COVID-19: A Driver for Disruptive Innovation of the Emergency Medicine Residency Application Process

Strategies for recruiting underrepresented in medicine and sexual and gender minority students to emergency medicine

Background

Despite having well-described benefits, diversifying the physician workforce has been an ongoing challenge. Within emergency medicine (EM), multiple professional organizations have identified expanding diversity and inclusion as top priorities. The following is a description of an interactive session held at the SAEM annual meeting addressing recruitment strategies for underrepresented in medicine (URiM) and sexual and gender minority (SGM) students into EM.

Methods

During the session, the authors provided an overview of the current state of diversity in EM. In the small-group portion of the session, a facilitator helped characterize the challenges programs face in recruiting URiM and SGM students. These challenges were described during three distinct phases of the recruitment process: (1) preinterview, (2) interview day, and (3) postinterview.

Results

Our facilitated small-group session allowed for discussing the challenges faced by various programs in recruiting a diverse group of trainees. Common challenges in the preinterview and interview day included messaging and visibility as well as funding and support. Postinterview challenges included communication and the ranking process. Through this exercise, we were able to collaboratively share ideas on tangible solutions that programs may use to overcome their specific challenges.

Conclusions

Given the importance of intentionality in diversifying the physician workforce, the authors describe successful strategies implemented within one residency program and those shared by session participants to overcome recruitment challenges.

Virtual Interviewing for Radiology Residency: Pluses, Minuses, and A Review of the Literature

This article reviews current medical literature to assess the benefits and drawbacks of virtual interviews for radiology residencies as well as the downstream effects of these changes, best practices, and potential future recruitment methods. Topics covered include the effects of remote recruitment in promoting accessibility and applicant diversity and equality as well as fiscal, environmental, and time savings in combination with technical challenges, the complications of over application, challenges in assessment of program culture and location, impact on morale, and hidden financial and emotional costs. Learnings from other medical specialties are highlighted in addition to the process of signaling, guidelines for conducting and participating in virtual interviews, and matters for future consideration.

Impact of the Virtual Format on Plastic Surgery Residency and Fellowship Interviews: A National Cross-Sectional Study

BACKGROUND

The 2020-2021 residency and fellowship application cycles were profoundly affected by the introduction of virtual interviews (VIs). The authors investigate the impact that the virtual format (VF) had on plastic surgery residency and fellowship interviews from the perspectives of program directors (PDs).

METHODS

Surveys were sent to PDs of integrated plastic surgery residency (RPD) and fellowship (FPD) programs to ascertain their perspectives regarding the VF's impact on residency and fellowship interviews. PDs were stratified into residency and fellowship cohorts, and comparative analysis was performed.

RESULTS

A total of 92 PDs, 28 RPDs and 64 FPDs, completed our survey (35%). When compared to in-person interviews, VIs were reported to be more economical and time efficient by RPDs (100% and 46%, respectively) and FPDs (97% and 48%, respectively). Consequentially, 36% and 47% of residency and fellowship programs were able to interview more applicants, respectively. RPDs and FPDs reported that VIs hindered their ability to assess applicants' fit with the program (75% and 63%, respectively), personality and communication skills (75% and 64%, respectively), and commitment to the field along with their ability to function as a trainee (57% and 50%, respectively). Overall, 71% of RPDs and 58% of FPDs preferred in-person interviews. The majority of residency (71%) and fellowship (56%) programs intend to conduct both in-person and VIs in future application cycles (p=0.12).

CONCLUSIONS

Despite preferring in-person interviews, PDs intend on hosting both in-person and VIs in future application cycles. It remains to be seen how VIs will be employed moving forward.

Virtual Interview Day: An AEGD's approach and assessment of interviewing during a pandemic

PURPOSE

A novel approach to interviewing for Advanced Education in General Dentistry residency positions became necessary during the COVID-19 pandemic. An efficient, virtual interview schedule, including video faculty introductions and clinic tour, was devised and executed to replace in-person interviews. The purpose of this study was to describe and assess this new way of managing virtual interviews.

METHODS

Forty virtual interviews were conducted via a web-based videoconferencing platform. Interviewers and applicants received surveys to be anonymously completed after interviews. The applicant survey gauged how helpful each component of the interview process was in their program ranking decision. The interviewer survey assessed time and knowledge needed for interviewing, clarity of instructions, and if they felt valued.

RESULTS

The response rate was 79% for applicants and 75% for interviewers. There was a high level of satisfaction from both applicants and interviewers. All interviewers reported that the team worked well together, instructions were clear, there was enough collective knowledge to answer questions, and they felt valued. There was a majority of positive responses for clarity of instructions and time with applicants. All applicants responded positively to correspondence with the Admissions Office, interview day instructions, informational PowerPoint, and sessions with the chief resident and program director. Regarding videos of faculty and clinic tour, there was a majority of positive responses. There were varying responses regarding the interview team being fair and nonthreatening. Lessons learned include reviewing on-camera behavior with interviewers, detailing the interview format in applicants' correspondence, requesting applicants photos in advance, allowing interviewers more time to study applicant material, and hosting a virtual happy hour for applicants and residents before the interview day.

CONCLUSION

Overall, the Virtual Interview Day successfully achieved the goals of applicant and program rank selection. Virtual interviews can be considered an alternative to in-person interviews.

An Evaluation of Non-Uniform Grade Distribution with the Emergency Medicine Off-Service Standardized Letters of Evaluation

INTRODUCTION

Standardized Letters of Evaluation (SLOEs) are designed to objectively compare medical students to their peers for completed emergency medicine (EM) rotations to be used in the EM residency match. In an attempt to adapt quickly to the lack of availability of in-person EM rotations due to COVID restrictions, "off-service" SLOEs (OSLOEs) were allowed in place of traditional SLOEs. The purpose of this study was to assess the utility of OSLOEs for candidate selection during the 2020-21 application cycle at a single EM residency.

METHODS

A retrospective cohort review of all OSLOEs submitted during the 2020-21 academic year to an EM residency program was performed. A total of 270 OSLOES were eligible for review. Summary statistics were calculated for the study variables recorded, including global rank, grade, categorical details, and rank.

RESULTS

Of the 270 OSLOEs reviewed, 61.9% ranked candidates in the top 10% of their class, with 95% being ranked in the top two categories. Over 90% of students were graded as honors or high pass and over 75% of students were ranked in the top 1/3 for each specific OSLOE category.

CONCLUSION

Our findings reveal questionable utility of the objective measures in the OSLOE as there are signs it may suffer from non-uniform grade distribution, leading to low utility for candidate selection. Our data shows marked over-ranking within the highest 2 categories. EM program directors and faculty should use caution as the OSLOE may not carry the same weight as a traditional SLOE when objectively evaluating prospective students for a match into EM.

Evaluation of Emergency Medicine Residency Programs' use of social media in the setting of the COVID-19 pandemic

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic significantly affected the ability of residency programs and applicants to interact using traditional methods of in-person interviews and visiting rotations. We examined the social media presence of emergency medicine (EM) residency training programs and how programs responded to the COVID-19 pandemic.

METHODS

The Electronic Residency Application Service (ERAS) identified EM residency programs that participated in the 2021 match. Programs were reviewed for the presence of a website and social media accounts on Twitter, Instagram, and Facebook, as well as foundation date. Data were collected after the ERAS application deadline.

RESULTS

All programs, except one, had some sort of online presence. A total of 258 websites and 476 social media accounts were identified. The majority of programs maintained an account on Twitter (75%), Instagram (61%), or Facebook (38%). Most Twitter and Facebook accounts were established before the onset of the COVID-19 pandemic. However, 46% of Instagram accounts were created after March 1, 2020. During 2020, there was a 34% increase in total social media account development, higher than in previous years.

CONCLUSION

EM residency training programs have a robust online presence. Account development continued to grow in 2020, after the onset of the COVID-19 pandemic, and growth on Instagram was noted to be substantial. Interactions through online platforms may supplement the residency application process, but their efficacy is unclear.

The Online Cross-Country Tour: Evaluation of a Novel Online Series for Canadian Radiology Residency Programs and Future Implications for the Radiology CaRMS Process

PURPOSE

The COVID-19 pandemic indefinitely cancelled visiting medical student radiology electives across Canada. In response, the Canadian Association of Radiologists Resident & Fellow Section (CAR RFS) and Medical Student Network (MSN) developed and evaluated an online series for medical students to learn about Canadian radiology residency programs.

METHODS

Medical students from any year of training were recruited through the MSN, local radiology interest groups, and social media to attend a 2-week online series of interactive sessions via Zoom with program representatives from Canadian radiology residency programs. A survey evaluating the online series, in particular its impact on residency and career planning, was administered to program representatives and students.

RESULTS

Fifteen of Canada's 16 radiology residency programs participated in the online series. A total of 212 students attended at least one session and nearly half were participating in the Canadian Resident Matching Service (CaRMS) this year. The postsurvey revealed that 77% of students agreed that the online series helped prepare them for CaRMS and ranking programs. The online series also benefited pre-CaRMS students as significantly more students were considering radiology as a specialty on the postsurvey compared to the presurvey. Students and program representatives agreed that this series should be held in future years, regardless of whether health and travel restrictions are lifted.

CONCLUSION

The CAR RFS and MSN hosted an online series for medical students to learn about radiology residency programs outside their home institution. Feedback was highly positive with important implications for the future CaRMS iterations for any specialty.

Candidate perceptions of the UK Recorded Consultation Assessment: cross-sectional data linkage study

The Recorded Consultation Assessment (RCA) was rapidly developed to replace the Clinical Skills Assessment (CSA) for UK general practice licencing during COVID-19. We aimed to evaluate candidate perceptions of the RCA and relationships with performance. We conducted a cross-sectional survey of RCA candidates with attitudinal, demographic, and free text response options, undertaking descriptive and factor analysis of quantitative data with qualitative thematic analysis of free text. Binomial regression was used to estimate associations between RCA pass, candidate characteristics and questionnaire responses.645 of 1551 (41.6%) candidates completed a questionnaire; 364 (56.4%) responders permitted linkage with performance and demographic data. Responders and non-responders were similar in exam performance, gender and declared disability but were significantly more likely to be UK graduates (UKG) or white compared with international medical (IMG) or ethnic minority graduates. Responders were positive about the digital platform and support resources. A small overall majority regarded the RCA as a fair assessment; a larger majority reported difficulty collecting, selecting, and submitting cases or felt rushed during recording.Logistic regression showed that ethnicity (white vs minority ethnic: odds ratio [OR] 2.99,95% confidence interval [CI] 1.23, 7.30, p = 0.016), training (UK vs IMG: OR 6.88, 95% CI 2.79, 16.95, p < 0.001), and English as first language (OR 5.11, 0% CI 2.08, 12.56, p < 0.001) were associated with exam success but questionnaire subscales, consultation type submitted, or extent of trainer review were not. The RCA was broadly acceptable but experiences were variable. Candidates experienced challenges and suggested areas for improvement.

Adult Reconstruction Fellowship Interviewee Perceptions of Virtual vs In-Person Interview Formats

Background

Owing to COVID-19, arthroplasty fellowship programs will be required to interview virtually for the current application cycle. Unrelated to COVID-19, our arthroplasty fellowship offered the 2019-2020 interviewees the option of an in-person or virtual interview. The purpose of the present study is to compare interviewee perceptions regarding in-person vs virtual interview formats from that application cycle at a single institution.

Methods

A 17-question survey was sent to all 26 interviewees (13 in-person and 13 virtual) shortly after the rank-list submission deadline. Interviewees were asked to what extent they agreed or disagreed with several statements, ranging from whether the interview was enjoyable to whether interviewees felt they were being adequately evaluated. In this Likert scale rating system, “strongly agree” was given 5 points (more positive outlook), and “strongly disagree” was given 1 point (more negative outlook). Chi-square analyses were performed.

Results

Seventeen interviewees (8 in-person and 9 virtual) returned questionnaires (response rate: 65%). Both in-person and virtual interview ratings were similar when averaged across all statements (4.5 vs 4.4, P = .67). In-person and virtual ratings were also similar for each individual statement (all P > .05). On average, interviewees spent $557/in-person interview. Fifteen (88%) said virtual interviews were more convenient, and 14 (94%) said they were more cost-effective.

Conclusion

At a single institution, perceptions on interview format, as quantified through Likert scale ratings, were similar between in-person and virtual groups. The vast majority also viewed virtual interviews as more convenient and cost-efficient. These findings have immediate implications for future fellowship application cycles.

Systems-Level Reforms to the US Resident Selection Process: A Scoping Review

BACKGROUND

Calls to reform the US resident selection process are growing, given increasing competition and inefficiencies of the current system. Though numerous reforms have been proposed, they have not been comprehensively cataloged.

OBJECTIVE

This scoping review was conducted to characterize and categorize literature proposing systems-level reforms to the resident selection process.

METHODS

Following Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, searches of Embase, MEDLINE, Scopus, and Web of Science databases were performed for references published from January 2005 to February 2020. Articles were included if they proposed reforms that were applicable or generalizable to all applicants, medical schools, or residency programs. An inductive approach to qualitative content analysis was used to generate codes and higher-order categories.

RESULTS

Of 10 407 unique references screened, 116 met our inclusion criteria. Qualitative analysis generated 34 codes that were grouped into 14 categories according to the broad stages of resident selection: application submission, application review, interviews, and the Match. The most commonly proposed reforms were implementation of an application cap (n = 28), creation of a standardized program database (n = 21), utilization of standardized letters of evaluation (n = 20), and pre-interview screening (n = 13).

CONCLUSIONS

This scoping review collated and categorized proposed reforms to the resident selection process, developing a common language and framework to facilitate national conversations and change.

Medical student experiences of applying into emergency medicine during the COVID-19 pandemic: A multi-institutional survey of emergency medicine-bound medical students

BACKGROUND

The COVID-19 pandemic added new and great uncertainty to the typical approach to applying into emergency medicine (EM) for medical students. There are little data on students' lived experience of applying during this time period. We performed a multi-institutional survey of EM-bound students' experiences with preparing to apply into EM during the pandemic.

METHODS

This was a cross-sectional survey design study of fourth-year students preparing to apply into EM during the 2020-2021 academic year. All self-identified EM-bound students at four participating institutions were recruited by email in June 2020 to participate in a 13-item, 5-point Likert-scale survey. Univariate descriptive statistics, response rate, and nonresponse bias were calculated.

RESULTS

Sixty-seven of 125 eligible students responded for an overall response rate of 53.6%. Nonresponse bias for specific survey items ranged from 0.01 to 0.12. Students rated the importance of securing an EM rotation at their home institution the highest of any item (mean ± SD = 4.81 ± 0.68). Students indicated higher satisfaction with advice from their department of EM (mean ± SD = 4.28 ± 0.75) than from their school of medicine (mean ± SD = 3.52 ± 0.89). Students indicated higher confidence in their home EM rotations' ability to assure adequate personal protective equipment (PPE; mean ± SD = 3.91 ± 0.83) than an away rotation (mean ± SD = 2.82, 1.09). Students reported feeling between moderately and quite stressed about applying into EM this year (mean ± SD = 3.49 ± 1.01), but reported the financial stress the lowest of any item (mean ± SD = 1.46 ± 0.84). Students rated it highly important that away rotations prioritize students from institutions without an EM residency (mean ± SD = 4.51 ± 0.93).

CONCLUSION

Medical students applying into EM during the COVID-19 pandemic felt confident in their EM advisors' recommendations and their home institution's PPE provision. Students with EM residency programs at their schools recognized the importance of away rotations being prioritized for students from schools without EM residency programs. Strong EM advising is important to students.

The COVID-19 pandemic as a catalyst for medical education innovation: A learner's perspective

The COVID‐19 pandemic has been transformative for healthcare and medical education. Physician trainees and the education system that serves them adapted quickly so that trainees could finish the academic year on time and advance to the next phase of training without compromising clinical competency or public safety. Systemic changes have had the most significant impact on telemedicine training, virtual learning, secure testing, and the interview process for residency and fellowship training positions. Trainees are now getting regular, supervised practice experience with telemedicine. Some secure testing is being done remotely, without jeopardizing examination test items or trainee assessment. Attending physicians are experimenting with novel ways to engage learners with video for virtual rounds to keep the rounding team safe. Finally, the interview process for medical school, residency, and fellowship programs, which has traditionally been an expensive and travel‐laden process, has been made completely virtual for the first time ever. These changes have disadvantages, including a lack of social connection, potential distraction when learning remotely, and limited contact with a potential training program when interviewing by video. This perspective paper, written by a senior internal medicine resident, details his firsthand experience with these changes during the pandemic. It also looks forward to how the current changes will likely change medical education permanently and for the better.