Students should have choice between in-person or virtual
(Bethesda, MD) The American Association of Colleges of Osteopathic Medicine (AACOM) strongly recommends that residency programs give students, from every background and medical school, the option to interview in person or virtually during the 2022-23 application cycle. The only way to ensure all medical students have a fair and equitable opportunity to match is to let the students decide how best to present themselves as they interview for positions they will have for the next three to seven years. This choice is especially important for minoritized communities in medicine, which include the 25% of all medical students with a degree in osteopathic medicine (DOs) as well as students underrepresented in medicine (UIMs) with a DO or MD medical degree. Speaking to this timely need, Dr. Robert A. Cain, AACOM President and CEO, issued the following statement:
Bias In Residency Decisions
“Implicit or explicit bias against certain types of medical students is an unfortunate, but very real, challenge in medicine. In just a few weeks, students will begin the application process to residency and as we head into this next cycle of the residency match, we have an obligation to mitigate these biases wherever we can. Enabling students to interview in person can help them be more competitive and alleviate certain disadvantages that plague minoritized communities as they seek a residency position. There are two things all medical students are asking for as they participate in this process – the first is accurate, timely and transparent information about the process itself; the second is a level playing field where everyone has the opportunity to compete fairly. In the spirit of meeting both these goals, today AACOM calls on all residency programs to offer both in-person and virtual interviews and allow students to choose which option best fits their needs.
As a February 2021 article in the Journal of the National Medical Association warned, “The move to virtual interviews can have a disproportionately harmful effect on UIM students…” and that “This shift to virtual interviews can potentially compound existing issues related to implicit bias as well as introduce new aspects of this bias in the residency application process.”
There is no doubt that in the previous two years, safety concerns due to the COVID pandemic rightfully took precedence. AACOM supported the recommendations that all interviews move online during this period, with the caveat that further research and study must be done before any future recommendations were made to limit or eliminate in-person interviews. Entering this next cycle in June 2022, thankfully, we are in a different place, with widespread access to vaccination and boosters; students learning in person; and the removal of travel restrictions. Based on the evidence, it is now permissible for students to travel to visit locations and interview with program directors. We also have survey data and direct commentary from students that eliminating the option of in-person interviews deepens discrimination against DO and other minoritized students. Conversely, to date, no formal studies have been done to ensure the bias of virtual interviewing is fully understood and no evidence has provided any guidance for how to mitigate that harm.
Why Virtual Interviews Disadvantage DOs and Other Applicants
One of the unique aspects of the DO professional history is that the care and training we provide often occurs in more rural areas of the country where it is most needed and would not otherwise exist. Yet that commitment to community-based training means that DO students do not have core residency-based clerkships in the larger, more urban academic medical centers where most residency positions are located. The same is true for many International Medical Graduates and some US MD students trained in more rural settings. The vast majority of US MD students are trained in larger medical centers; therefore, they do have more exposure to residency programs during their clinical training and have greater opportunity to interact with program directors who make the decisions about which applicants match. Virtual interviews for MD students pose less risk to the overall strength of their application, while weakening those of DOs and others.
We Need to Listen to Students
Crucially, at a time when the medical community is working to foster diversity and create more inclusive environments, we should be taking every opportunity to eliminate discriminatory practices. Underrepresented and minoritized communities have expressed a preference for in-person interview experiences to be able to more fully assess the suitability of a potential residency environment. We cannot forget that students are considering entering a years-long, all-encompassing relationship with the residency program they choose.
Not giving students the opportunity to fully explore the environment and community they are committing to risks higher dropout rates and adds to the ever-increasing burnout in the profession. The mere option is what today’s medical students are asking for, allowing them to take into consideration the cost of traveling in the context of their overall student debt. A 2021 survey of all students in the Match conducted by National Residency Matching Program showed 51.4% of all students preferred in-person interviews and only 20.7% reported a preference for virtual. AACOM’s survey of osteopathic medical students found that a majority of the more than 1,000 respondents believed that if a program only offered virtual interviews, they would be disadvantaged compared to other students.
We Need to Listen to Program Directors and Deans
Program directors in rural and/or underserved communities find it more difficult to attract students unfamiliar with those localities. In person interviews allow them to better assess the real desire of students to learn and serve there. A 2021 National Residency Match Program (NRMP) survey reported that 66% percent of programs directors found virtual interviews to be a disadvantage in assessing candidates’ interest in programs and 67% saw them as a disadvantage in assessing candidates’ interpersonal skills and alignment with the program. We should not ignore the input of the individuals who are most impacted by this issue.
In an AACOM survey, 100% of the Deans of Colleges of Osteopathic Medicine who responded support the position that programs should offer virtual and in-person interviews. Deans and faculty of osteopathic medical schools know that many residency programs, especially in competitive specialties, will not consider applicants they have not seen in their clinical environment. And while visiting programs is not free, the cost of travel is minimal and can be reduced as students select fewer programs for in-person interviews and complete others virtually. No doubt there is also a cost for programs to hold in-person interviews, yet the long term benefits far outweigh that line item in an overall budget. Students need to be able to connect in person if that is their decision and programs need to provide that opportunity.
A Call to Action for Residency Programs
AACOM is committed to ensuring DO students and all minoritized communities within medicine have an equal opportunity to find a residency program that best fits their needs as they continue on the path to becoming a physician. We therefore strongly recommend that all residency programs offer both in-person and virtual interviews for the 2022-23 application cycle. We must root out discriminatory practices in medicine wherever possible and remove barriers to diverse, talented, committed students becoming physicians. Giving students a choice in how they compete for residencies is a seemingly small, but in practice, very important, step in that direction.”
The American Association of Colleges of Osteopathic Medicine (AACOM) leads and advocates for the full continuum of osteopathic medical education to improve the health of the public. Founded in 1898 to support and assist the nation's osteopathic medical schools, AACOM represents all 38 colleges of osteopathic medicine—educating nearly 34,000 future physicians, 25 percent of all U.S. medical students—at 60 teaching locations in 34 U.S. states, as well as osteopathic graduate medical education professionals and trainees at U.S. medical centers, hospitals, clinics and health systems.
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