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Reviews: The Training Room

Interviewing in the Wake of COVID-19: How Orthopaedic Residencies, Fellowships, and Applicants Should Prepare for Virtual Interviews

Hagedorn, John C. II MD; Chen, Jie MD, MPH; Weiss, William M. MD; Fredrickson, Saul W. MD; Faillace, John J. MD

Author Information
Journal of the American Academy of Orthopaedic Surgeons: April 1, 2021 - Volume 29 - Issue 7 - p 271-277
doi: 10.5435/JAAOS-D-20-01148
  • Free
  • COVID-19

Abstract

In response to the COVID-19 pandemic and concern for the safety of applicants and programs, the Coalition for Physician Accountability's Work Group released “Medical Students in the Class of 2021: Moving Across Institutions for Post Graduate Training,” essentially mandating virtual interviews for the class of 2021.1 However, the policy of virtual interviews did not stop with medical students but was slowly expanded to fellowship interviews across medical and surgical subspecialties.2,3 Many specialties, such as internal medicine, have conducted virtual interviews for several years,4,5 contrasting with the relative paucity of virtual interviews at all levels of the orthopaedic training process.6 Numerous studies have previously shown the heavy reliance on in-person interview performance as a key selection criteria in orthopaedic residency and fellowship interviews.7,8 During in-person interviews, programs can evaluate a candidate's personality and attitude, verify application information, and physically show applicants the programs' strengths, such as laboratory space, resident work spaces, and libraries.9-14 In a similar fashion, orthopaedic residency and fellowship candidates favor in-person interviews to judge a department's working environment and organization and interact with the current trainees.15-18 Thus, the general hesitation of candidates and programs toward virtual interviews is understandable in light of the perceived amount of information that can be obtained by each side during an in-person interview despite the successful implementation of virtual interviews in other fields of medicine and business.19-21 The goal of this review was to help introduce the virtual interview to orthopaedic residency and fellowship programs and applicants to highlight the benefits of virtual interviews and assist both programs and candidates with tips to prepare for impending interview sessions.

What is a Virtual Interview?

Although virtual interviews may be new to many fields in medicine, they are commonplace in the business world. A 2013 survey revealed that 63% of human resources managers had already transitioned to virtual interviews over traditional, in-person encounters.22 With the advancement of video conferencing technology since 2013, the prevalence of virtual interviews is established and has been pushed to the forefront by the COVID-19 pandemic.23

Virtual interviews can be one way or two way.24 In a one-way virtual interview, the candidate would be sent a list of questions to be answered and returned in a video format.24 In two-way interviews, the exchange between the program and the candidate is more like a traditional in-person interview, where questions are asked and responded to in real time via video conferencing.24 Most studies in medicine regarding virtual interviews have focused on two-way interviews,5,6,25 which are typically conducted via video-conferencing platforms such as Skype, WebEx, Microsoft Teams, and Zoom.26 As in a traditional interview, a virtual interview can have multiple rooms for interviewees to visit, allow for large group interviews, real-time digital content sharing and presentations, and multiple candidates for a position can interview at the same time on the same day.26

Benefits of a Virtual Interview

Virtual interviews are viewed by some as detrimental to both the candidate and the program in the selection process. In one study, 30% of candidates who took part in a virtual interview for an adult reconstruction fellowship felt that it was not the appropriate format when compared with in-person interviews.6,27 Although the potential drawbacks of virtual interviews are still not quantified, direct benefits exist that can be gleaned from the process (Table 1). One of the biggest obstacles for both candidates and programs is the cost of an in-person interview. Fogel et al28 surveyed orthopaedic residency surgery candidates and found that, on average, each candidate borrowed just over $7,000 to attend an average of 15 interviews, 72% of applicants borrowed money to interview, and 28% cancelled interviews because of financial constraints. Oladeji et al29 found that the average cost for orthopaedic residents applying to fellowships with 11 interviews was just over $5,000. For medical students and residents with little discretionary income, the cost of interviews can be overwhelming and add to a candidate's educational debt and stress. Orthopaedic programs also incur considerable expenses with in-person interviews, including social events, interview-day meals for candidates and faculty, event coordination, and lost revenue from cancelled clinics and procedures because of faculty participation in interviews. Conducting interviews virtually can dramatically decrease many of the costs to the applicant and program. Edje et al compared two groups of candidates interviewing for residency positions. Those who had Skype interviews had notably lower costs than those participating in traditional interviews, with cost savings of just over $5,000 on direct and indirect expenses (eg, faculty time).30 These reduced costs could potentially offer candidates and programs more interview opportunities than possible with traditional interviews.

Table 1 - Benefits of a Virtual Interview Compared With an In-Person Interview
Factor Program Candidate Both
Decreased cost x
Flexibility in scheduling x
Decreased travel stress x
Levels playing field for candidates x
Easier document review and note-taking during interview x
Ability to share unique content x

Virtual interviews have the added benefit of allowing more flexibility in scheduling. Because candidates and faculty do not have to physically be in the same place at the same time, programs can set up interviews in a manner that works for them. This has most recently been used in medical school interviews, where candidates can meet multiple faculty during one interview via an online platform,31 potentially giving both sides a broader view of the program than would be possible in a traditional interview. Virtual interviews also minimize stress on applicants and programs caused by travel delays.32

Virtual interviews also place candidates on similar footing and can potentially eliminate bias. For example, most video-conferencing platforms allow time limits to be set so that each candidate and interviewer has the same amount of time to evaluate each other. In addition, certain characteristics of interviewees (eg, taller height) that can lead to more favorable reception and even higher pay are eliminated by virtual interviews.32

Finally, virtual interviews allow the opportunity to take notes and review documents. If you are interviewing someone in person, they can potentially see what you have written about themselves or others. In a virtual interview, notes can be taken and the candidate's application reviewed, all while speaking with the candidate.32 The more detailed the notes, the better program and candidates can remember the strengths and weakness when developing a rank list. Candidates, on the other hand, can show digital content of materials that demonstrate qualifications for the job or showcase their publications, hobbies, or other content that they could not bring to a traditional interview setting and ultimately help demonstrate why they are qualified for the position.

How to Prepare for a Virtual Interview

Candidate

Preparation for an interview, whether in-person or virtual, is the number one factor for success.33 Many elements of traditional interview preparation, such as knowing your application, being able to field questions, and give appropriate responses, are still relevant. However, a few nuances exist of virtual interviews that are not experienced during in-person interviews (Table 2). The biggest factor to prepare for is where you will conduct the interview. The room you select should be quiet, and the applicant should be able to control noise in or around the room.23,33-35 It should also be clean, free of pets, people, and other distractions and have a plain wall or background.23,34,35 Lighting should be in front of or diagonal to the candidate, not behind.23,35 Finally, the room should have a door that can be locked during the time of the interview, ideally with a sign posted to notify passersby to keep noise to a minimum.23,33,34

Table 2 - Candidate Preparations
Objective Description
Select a quiet room No distractions, ability to control noise, and notifications on computer/phone
Appropriate lighting Light in front or diagonal to candidate, not behind
Ability to secure the room Door lock and can place sign indicating interview occurring
Stable internet connection WiFi or wired
Working equipment Computer/tablet, camera, and microphone/speaker
Test video conference platform Know how it works and computer/tablet/camera/microphone speaker work with it
Equipment position Camera at eye level/shows top 1/3 of body
Practice mock interviews Record or work with another person on another computer
Equipment check night before Charged and close to outlets

Once the room has been selected, the technology to conduct the interview needs to be in the room and functional. The biggest limiting factor on interview day can be a poor internet connection, leading to unstable video. Ensure that the selected room has a stable WiFi or wired connection to the internet, and, if concerned, test the connection speed with one of many free internet speed-testing websites.23,33-35 The next step should be setting up the hardware to conduct the interview. Any internet-connected devices that allow a camera, microphone, and the ability to load the platform being used will work; however, consideration should be given to using a tablet or computer over a phone because a tablet or computer often has a stable base. Even if a computer/tablet is used, notifications, other video calls, or phone calls can be received. These notifications should be turned off or removed during the interview to minimize distractions.23,33,35 If using a separate microphone/speaker, such as earbuds and/or a separate camera, make sure these items have plugs available in the room to either be charged or plugged in during the interview. In addition, make sure that the camera is at the eye level and the microphone is in a position to allow uninhibited usage.33

Once the computer and audio/visual components are set up, it is time to ensure that the software is working. Contact the program to ensure that the correct platform (ie, Zoom) for the virtual interview has been obtained, as well as the login details for interview day.33,34 When registering to use the software, or if registration occurred previously, make sure the username is professional and helps identify you as the candidate.23 Once the virtual interview platform is installed, ensure that the computer, camera, and microphone/speaker work with the software. The camera should show the top third of the candidate's body, and the candidate should adjust their position or components as needed to accomplish an appropriate view.33,34 Virtual backgrounds should be avoided because they can serve as a source of distraction during the interview, either because of a nonprofessional nature or color scheme.33,34 Finally, if screen sharing is anticipated, test out the ability of the platform to adequately share the computer screen, video, picture, and document files. If the room selected initially is in a public space and the setup of the computer cannot be left in place, be sure to note the exact location of the computer, camera, microphone, table, and chair to recreate the setting quickly on interview day.33-35

It is imperative to practice using the virtual interview software, either with someone else or by self-recording. During the practice session, the candidate should ensure lighting, camera position, and background are appropriate;33,35 be aware of facial expressions; and confirm that they are looking at the camera when speaking, not at the computer screen. Practice sharing content and using the other functionalities of the virtual interview software. The night before the interview, the candidate should make sure to charge all components and have a water bottle, pen, and paper within reach.23,33,34 Of note, if the program has a virtual reception the night before, this can be a good opportunity to test the setup on the program's platform before the interview day.

Program

A program's success, like the candidate's, is predicated on good preparation (Table 3), which is critical leading up to virtual interviews, because one blunder can be perceived by a candidate as a bigger systemic issue within the program.15 The first step in preparation is finding a platform. Platform choice may be limited by institutional policies, institutional computers, internet connection, and other factors. When selecting a platform, consider the goal of the interview.26,36 For instance, does the program want to have several one-on-one interviews on the same day at the same time or do they want to have a few large group interviews? Does the program want the ability to have breakout rooms, presentations, and content sharing from candidates? Once the goals for interview day have been established and the platform selected, testing should occur to make sure the platform works as desired. Multiple faculty and staff should log on and conduct mock interviews, including moving people on the virtual interview software into and out of interview rooms.26,36 The platform should be stressed to ensure that it can handle the demands of the interview day. Interviewers should conduct their tests from the same location they will be using on the interview day, and all audio/visual equipment should be checked. Be familiar with the software and, if needed, attend classes to educate and assist interviewers before the interview day.

Table 3 - Program Preparations
Objective Description
Determine platform Will accomplish programs goals and will withstand interview-day demand
Establish standard operating procedures Who to call if technical issues, etc.
Conduct mock interviews Simulate interview to work out issues before interview day
Communication with candidates Standard operating procedures, expectations, platform, and timeline for the interview day
Establish ways to demonstrate culture Slide show between interview and presentations by residents/faculty

Once the virtual platform software testing has occurred, guidelines should be established regarding the program's approach to the interview. For example, in case of technical difficulties, how would the interview continue? If an applicant signs on late, how will it impact the remainder of the schedule? Will paper or digital copies of the candidate's application be distributed? These are just a few examples of a number of issues to consider. One protocol that should also be considered is how to give a consistent culture message. With the virtual interview, it can often be difficult to portray culture compared with in-person interviews, so having consistent messaging via resident/faculty presentations and background slides/information between interviews can help convey the program's culture to the candidate.26 Once the program's protocol has been established, it should be sent out to the candidates invited to interview, along with the software platform, an interview-day timeline, and contact information. Programs should incorporate an appropriate amount of time between interviews to account for any time it takes to assign candidates and switch between rooms. E-Mail communication should include the link or a calendar invite.26,36 If a virtual reception is to be held the night before, this is a good opportunity to test the system, and formal receptions have been shown to help in medical student recruitment.37,38

How to Perform on Virtual Interview Day

Candidate

Much of the success on the day of the interview stems from the preparation that occurs beforehand (Table 4). On the interview day, applicants should be well rested and dress professionally, just as if an in-person interview was being conducted.23,33-35 Arrive at the selected interview room 30 minutes before the interview begins and check that all equipment is charged and chargers are nearby, retest audio/visual equipment, and log on early to the software platform.33,34 Ensure that all unnecessary programs/notifications are turned off on the computer. A pen and paper should also be nearby but try to avoid using notes during the interview.

Table 4 - Candidate Performance Expectations
Objective Description
Treat it like an in-person interview Be well rested and dress as if you are going to an in-person interview
Test equipment Computer/tablet, camera, and microphone/speaker working
Prepare the desk Water bottle nearby, outlets/charger close, and pen/paper
Check notifications Turn off notification on computer/tablet/phone
Sign on early 15 min before the interview starts
Make up for lack of body language Facial expressions and voice inflection
Limit question answers 90 sec maximum per response
Technical issues Stay calm, know the program's back-up plan, and have own back-up plan

Once the interview begins, look at the camera, use facial expressions, and avoid speaking in a monotone voice.33-35 Because of the camera being only on the upper third of the candidate's body, traditional body language cannot be used as effectively to show interest, and facial expressions and a candidate's voice are the two primary tools they will have to show interest. Limit responses to 90 seconds or less.23 Typically, traditional interview social norms do not allow the interviewer to drift off and become disinterested; however, in the virtual platform, this happens much more easily, so keeping answers short allows the interviewer to stay engaged and interested.23 Technical issues may arise during an interview and can be as simple as broken audio/video to complete system shutdown. If a technical problem arises, stay calm and do not become flustered. Know the program's backup plan, or, if the program has no plan, make sure you do. It could be as simple as providing your phone number at the beginning of the interview to continue the interview via telephone if technical problems occur.23,34 At the conclusion of the interview, be sure to thank the interviewer and attend any debriefing or other sessions offered, such as video tours or breakout rooms with residents.

Program

On the interview day, interviewers should join early to make sure that equipment is working and the program is running on time (Table 5). It can be awkward or difficult for both candidates and interviewers to feel comfortable in virtual interviews.36 In the virtual-interview setting, the interviewer should acknowledge the uniqueness of the situation and make the candidate feel comfortable.36 The interviewer should act as they would during an in-person interview, with no deviation because of the virtual platform. The interviewer should quickly reiterate any end-of-interview warnings and alert the candidate to any distractions, such as pages, that might occur during the interview. Finally, the interviewer should make an effort to promote the culture of the program in coordination with other initiatives prepared before the interview day.36

Table 5 - Program Performance Expectations
Objective Description
Sign in early Time to check computer, camera, and microphone/speaker
Make candidate comfortable Acknowledge uniqueness of situation
Act normal Do not act differently than an in-person interview
Alert candidate about interruptions Pages, kids, pets, and warning interview is ending
Promote culture Reiterate and demonstrate programs culture

Summary

Many changes have occurred in the world because of the COVID-19 pandemic. Although in-person interviews may allow programs and candidates alike to judge their compatibility with one another, virtual interviews offer notable benefits to applicants and programs. Virtual interviews result in notable cost reductions to programs and, especially, applicants, who often have little discretionary income. In addition, virtual interviews allow candidates to compete on a level playing field, have flexibility in scheduling, and eliminate delays that can occur from travel during traditional interviews. A number of steps can be taken to prepare programs and candidates for success on interview day while overcoming some of the perceived limitations of virtual interviews. Overall, although in-person interviews have been the gold standard for the resident and fellow selection in orthopaedics, virtual interviews offer benefits not seen with traditional interviews and, with proper preparation, can offer an informative and satisfactory experience for candidates and programs alike.

References

References printed in bold type are those published within the past 5 years.

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Copyright 2021 by the American Academy of Orthopaedic Surgeons.