I recently had a conversation with the 10-year-old son of a colleague, and I asked him if he wanted to be a doctor someday. Without missing a beat, he replied, “No, I want to be a YouTuber.” Being half way through my sixth decade of life, I gave an age-appropriate response: “You want to do what?”
A quick Google search on this topic landed me on a webpage listing “The Top 10 YouTube Earners of 2017.” It turns out this is a lucrative profession. The top earner (Daniel Middleton or “DanTDM”) will make $16.5 million this year. The number 10 entry, Lilly Singh, is scraping by at $10 million. So much for medical school. I need to invest in the kid sitting next to my bar stool. (Business Insider Dec. 8, 2017; http://read.bi/2Dtkii4.)
A quick look at these millionaires' content reveals pretty superficial material. Nearly all of it is pop culture sarcasm ridiculing life. Ironically, it sounds similar to most conversations in the ED physician lounge.
It turns out, though, that looking good on a laptop camera might get you into an emergency medicine residency. Starting this year, all medical students pursuing EM training participated in a new component of the application process, the Standardized Video Interview. The SVI consists of six questions designed to assess interpersonal communication skills, medical knowledge, and professional behavior.
The goal is to give programs the ability to see and hear the applicants prior to offering them a traditional in-person interview. The applicant's responses are analyzed to generate an overall score that can be utilized for interview selection or rank list position. Currently, only applicants to EM programs are participating in the SVI program. (AAMC May 2, 2017; http://bit.ly/2DiQG2S.)
Using the SVI generates many interesting questions and potential dilemmas. An obvious one is how an applicant's ability to interact with a screen translates to successfully interacting with patients, staff, peers, attendings, and consultants in person. The applicant is not actually interacting with anyone during the SVI. They are provided with a standardized question and then have 30 seconds to formulate an answer before answering on camera.
It's not a stretch to hypothesize that their comfort level with having a conversation with a camera would significantly affect their performance, which gives YouTubers who have practice with performance a big advantage. I have spent a fair amount of time doing this myself, and it is a completely unnatural experience.
No More Code Words
SVIs also seem to fly in the face of what medical schools want program directors to focus on when considering their graduates for residency positions. It is evident to me that schools increasingly push back or eliminate many of the metrics used by residency programs in the past to assess medical school performance. Grade point averages and class ranks are no longer in vogue. Most schools utilize pass/fail grading systems for basic science classes and avoid categorizing overall performance in medical school relative to classmates.
Even the code phrases—exceptional, superior, excellent, very good, and good—that used to provide a succinct summary for each applicant are becoming less common. This forces programs to focus on the extended narrative summaries from an applicant's clinical rotations to determine his likelihood of success during residency. That said, how do SVIs give a better indication of an applicant's clinical potential? These are two entirely different skill sets.
And does the increasing number of requirements associated with the application process make it better? Program directors are typically buried by more than 1,000 applications each year, and September and October are spent in seclusion in a vain attempt to process millions of data points into a coherent strategy for figuring out who to invite for interviews. Now they have 15 to 20 minutes of video material per applicant to analyze as well. If you do the math for just 500 applicants, the poor program director will have to spend 125 hours just looking at video.
The most compelling concern to me, however, is the exponential increase in the anxiety associated with interviewing for post-graduate medical training. Applying for residency positions has always been stressful. After years of competing in high school and college to achieve academically, the proverbial vice on each applicant has been ratcheted tighter by 30-page applications, the need for stellar board scores, and multiple standardized letters of evaluation from no fewer than two EM programs.
Since becoming an academic attending in the 1990s, I have witnessed the anxiety level (not to mention the financial burden) for each applicant climb higher year after year. It is now routine that the average EM applicant applies to 50 programs. (I interviewed one man who told me he applied to more than 100.)
As I watch the SVI responses of young men and women staring into a faceless camera, I think of the pools of sweat created by the process. There may be value in seeing how an applicant handles pressure, and the developers of the SVI program could be commended for exploring innovative strategies to assess applicants. Nonetheless, academic EM leaders need to be careful about creating more bureaucracy in an already overwhelming and taxing process.
Despite all the benefits of technology, medicine is still a profession of intimate personal interaction and human touch. For me, the process of shaking an applicant's hand and exchanging small talk provides more insight than videos created in an artificial setting.