To the Editor:
The COVID-19 pandemic has required physical distancing and a reimagining of health care delivery. Almost overnight, telemedicine protocols were expanded to ensure health care could still be delivered to patients.1,2 To minimize transmission of SARS-CoV-2, stay-at-home orders were implemented for nonessential workers, prompting schools to transition to virtual and remote instruction. While much of medical education successfully transitioned to remote learning, clinical rotations and externships were put on hold.3,4 Given the expected duration and necessity of travel restrictions, the Accreditation Council for Graduate Medical Education recommended that residency interviews be conducted virtually in the upcoming 2021 application cycle. This provides an opportunity to reimagine the application process for this year and beyond using technology to make the process more accessible, affordable, and equitable to applicants regardless of their distance or resources.
In the current model, residency programs screen applicants for interviews based on their academic credentials and fit for the program. This resource-intensive process is limited by programs’ interview capacity and applicants’ ability to travel, which can be cost prohibitive.5 Alternatively, after an initial application screen, programs could conduct a first round of virtual interviews to learn more about applicants while offering more interview slots than would be possible with traditional in-person interviews. By casting a wider net, programs and applicants would have more opportunities to learn about one another, without expending the resources associated with in-person interviews. Programs could then conduct a second round of interviews with those applicants in whom they were most interested. These second-round interviews could be virtual this year and in-person in subsequent years. Additionally, programs and applicants may even choose to rank each other in the absence of a second-round interview to reduce the risk of unfilled residency slots or not matching, respectively.
Technology has led to significant innovations in the quality, safety, and delivery of health care and has proven effective in overcoming physical constraints during the COVID-19 pandemic. Similarly, technology can improve the residency selection process by providing more access, equity, and efficiency this year and well beyond the current crisis.
1. Cutler DM, Nikpay S, Huckman RS. The business of medicine in the era of COVID-19 [published online ahead of print May 1, 2020]. JAMA. doi:10.1001/jama.2020.7242
2. Keesara S, Jonas A, Schulman K. Covid-19 and health care’s digital revolution. N Engl J Med. 2020;382:e82
3. Rose S. Medical student education in the time of COVID-19 [published online ahead of print March 31, 2020]. JAMA. doi:10.1001/jama.2020.5227
4. Emanuel EJ. The inevitable reimagining of medical education. JAMA. 2020;323:1127–1128
5. Agarwal N, Choi PA, Okonkwo DO, Barrow DL, Friedlander RM. Financial burden associated with the residency match in neurological surgery. J Neurosurg. 2017;126:184–190