If the COVID-19 pandemic hadn't forced much of the world to get comfortable with a virtual environment, Liza Smith, MD, doubts that many residency programs would rely on virtual platforms to interview prospective trainees. Today many only interview virtually.

Smith, who is an associate professor, clerkship director, and associate program director of emergency medicine at UMass Chan Medical School - Baystate in Springfield, Massachusetts, chairs the Council of Residency Directors in Emergency Medicine (CORD) 's Application Process Improvement Committee and has helped craft the specialty's guidelines for interviewing medical students seeking an emergency medicine residency.

"Emergency medicine is a specialty that tries to be evidence based," Smith says. "There's lots of evidence supporting virtual interviews as a way to reduce burden financially, environmentally, and time-wise, and as a way to promote equity and diversity."

The Association of American Medical Colleges (AAMC) has released guidance for residency programs along with a recommendation that residency and fellowship programs continue to interview virtually for a number of reasons, including reducing the financial and environmental impact of unnecessary travel and helping to improve equity and reduce bias in the interview process. The result is that all but a handful of medical schools and many residency programs have continued with a virtual-interview format.

Tips for a successful virtual interview

Marcy Verduin, MD, a professor of psychiatry and associate dean for students at the University of Central Florida College of Medicine Health Sciences Campus at Lake Nona, offers the following tips for students who are interviewing virtually:

1. Sometimes virtual interviews may feel less formal, simply because you are sitting in your home or in a room in the medical school. But virtual interviews should be treated just as formally as an in-person interview. Dress fully for the interview, down to the dress shoes, as if you were in person.
2. Consider your background (what will the interviewer be able to see in the background, and what does that say about you?).
3. Consider lighting (perhaps purchase an inexpensive ring light and web camera for this purpose).
4. Make sure you are somewhere private and quiet, where you will not be interrupted.
5. Have a backup plan in case you have technical difficulties (e.g., the number of the program coordinator to call in case you lose Wi-Fi).
6. Make sure your visible Zoom name is your full name, with your title or year in school and the name of your medical school (e.g., Jane Smith, M4, University of Central Florida COM), to make it easy for interviewers to remember you.

Still, in its guidance, the AAMC recognizes that not all programs find that the benefits of virtual interviews outweigh the cons.

"Every program has their own unique mission, goals, and context, and thus may take different approaches for sound reasons," the AAMC guidance states. "We recognize that what is best for one program may not be best for another. Each institution should evaluate the pros and cons of interview formats in their unique context to determine what is best for their program and/or specialty."

The case for virtual interviews

The AAMC's guidelines offer several considerations for programs weighing virtual interviews, foremost of which is the reduction in cost to applicants. This can also make the process more equitable, ensuring those who cannot afford to travel to as many sites have an interviewing experience similar to those with the means to travel widely. An AAMC survey found that interviewing students spent anywhere from $400 to $7,000 on travel to interviews during their Match cycle, with a median cost of $3,000.

Smith says that the equity issue is of particular concern to emergency medicine programs, since a third of applicants are applying from international medical schools and traveling to interview in-person could be prohibitively expensive for them.

Students have also appreciated other benefits of virtual interviewing, including being able to interview in a familiar environment and to accept more interviews without missing as much clinical training time, explains Marcy Verduin, MD, a professor of psychiatry and associate dean for students at the University of Central Florida College of Medicine Health Sciences Campus at Lake Nona.

"Personally, I like to see programs using virtual interviews. I would have been hesitant about this prior to the pandemic, but we've seen how effective they can be," she says. "I'm not against an in-person experience, and I think a great way to accomplish this is through an optional second-look experience after the virtual interviews."

Some programs may conduct interviews virtually but offer applicants who are seriously considering the program an opportunity to visit the campus and have interactions with faculty and residents that do not influence their evaluation. The AAMC encourages institutions that can offer travel financial assistance to do so for students who qualify for the AAMC's Financial Assistance Program .

Cutting down on unnecessary travel also can help reduce academic medicine's impact on the environment. Though estimates of the environmental impact of switching to virtual interviews vary, some surveys suggest that there could be some reduction of carbon emissions associated with virtual interviewing. (Air travel in particular has a large carbon footprint, as emissions stay in the upper atmosphere. This can warm the planet for centuries.)

Ensuring a good fit

While most residency programs have opted to interview virtually during the 2024-2025 cycle, several, especially those for surgical specialties, have returned to conducting interviews in person.

"It's a complex decision because there are clearly some advantages to virtual interviews, but there are also some disadvantages," says Marc Thorne, MD, a clinical professor and associate chair of education of otolaryngology - head and neck surgery (ENT) at the University of Michigan Medical School. "The ability of the program and applicants to get a sense of the culture of the program - that's harder to convey in a virtual-interview format. You miss out on informal interactions and, from the applicant perspective, seeing how residents and faculty interact."

Thorne says that since surgical specialties tend to have longer residencies and smaller cohorts, they generally prefer extended, in-person interviews, to ensure that both those in the program and those considering joining it understand if it is a good fit.

The Organization of Program Director Associations partners with the AAMC to create application guides for different specialties. The program director associations for 22 specialties shared their suggestions for the 2024-2025 interview cycle, most of which recommended virtual-only formats. However, neurosurgery program directors encouraged programs to host in-person interviews, ENT program directors said they anticipated most of their specialty's programs would conduct in-person interviews, and dermatology, orthopedics, and general surgery program directors emphasized that the decision should be up to individual programs, to meet their needs.

"An in-person interview gives [interviewers] an opportunity to really look at everything in the potential candidate," says Rita Raio, manager of graduate medical education (GME) training programs at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New York, and president of the Association of Residency Administrators in Neurological Surgery. "They look at body language … and all interviewers have different things they've picked up during the conversation. It is my opinion that in-person interviews give a more comprehensive approach to the entire interview process."

Raio says that neurosurgery-residency interviews often span two days and include opportunities for candidates to tour the campus and interact with faculty and current residents. Given that a neurosurgery residency is a seven-year commitment, Raio adds that those additional elements are important in the selection process for both parties.

"Having it in person really lends quite a bit," she says. "You get to identify whether or not the person is a good fit with the existing team and residency program."

Surgical-residency programs aren't the only ones holding in-person interviews, however.

Although CORD strongly encourages emergency medicine programs to hold virtual interviews, some programs have opted to return to in person, Smith says. These programs tend to be ones in lesser-known geographic areas or those that had trouble filling their residency spots during recent Match® cycles. The hope is that bringing candidates to interview in-person could give them a better sense of which applicants are serious about the institution as well as give them an opportunity to win over applicants, she explains.

Leveling the field

And while Smith understands the reasoning behind holding in-person interviews, she believes the sum of the benefits of virtual interviewing outweighs the downsides.

"I don't think it's entirely the same experience - there is something lost," Smith says. "But is it worth [losing] all the positive effects? We're willing to give up that little bit extra for all those additional benefits."

Thorne also acknowledges the equity concerns surrounding in-person interviews and says that programs have made and should continue to make adjustments to minimize the negative impacts.

For example, the University of Michigan Medical School's ENT residency program offers a stipend to defray the cost of accommodations for interviewees.

Some specialties have also started requiring applicants to "signal" their top choices in order to help programs focus on the applicants who are more likely to rank the program highly. More than 4,000 residency programs are participating in program signaling for the 2025 ERAS® application season.

Thorne says that ENT was one of the first specialties to implement signaling and allowed applicants to signal their top 25 choice programs. This has helped reduce the overwhelming number of applications for selection committees to evaluate and has also limited the cost and effort of students applying to scores of programs.

"That's translated into fewer applications per program, which had the potential to create anxiety but, in general, was well received," he says. "It allows each program to really have more time to find those applicants that are best suited."

Regardless of the interview format chosen, Smith emphasizes that students appreciate consistency and transparency from programs throughout the process. She urges those involved in interviewing applicants to be aware of the stress they're placing on students when it's unclear whether not participating in an in-person interview or event could hurt their chances.

"That's the psyche of the medical student: 'Don't do anything that will put you at a disadvantage,'" she says. "It's so hard not to have some unconscious impression of someone who interviews in person. To reduce bias, whatever your program chooses to do, [it should] make every effort to be transparent."