It’s already a common cliché to say “2020 sucks” or “oh another terrible thing happened…of course it did, it’s 2020!” But this year has certainly rent the veneer of normalcy asunder, illustrating the many challenges we must face as a society going forward…cultural, political, biological, climatological, global. Whoa. That’s a bit heavy. Too much for this casual blog. So let’s hone down from the seemingly insurmountable to what the title of this post really reflects: how the Covid-19 era affects you – residency applicants for the 2020-2021 cycle (and even most applicants in the current 2022-2023 cycle).

As all residency applicants are aware, in light of Covid-19 the AAMC has recommended that all residency interviews be conducted virtually. If you’re an applicant and that’s news to you…well…best of luck I guess. For the rest of you who are aware of the world around you, let’s talk.

By now we’ve all endured the drudgery of video conferencing, e-learning, and the like. It kind of sucks. I harbor a special type of hatred for the Zoom and Microsoft Teams apps on my laptop. For residency applicants, the future profession you’ve toiled towards for years now hangs in the balance of appearing charming on a tenuous internet connection. A lot of medical students have asked me about this over the last several months. So many had the same string of questions and concerns that I decided to compile the information and make it available to everyone.

First I’m going to provide some data about the 2020 NRMP Match. Always good to start with a basis in reality. And just a fun fact, this was the first unified Match for all MD and DO students, and the largest Match in history with over 40,000 participants.
Second, I’ll discuss the 2020 NRMP Biennial Program Director Survey. Yes, that’s a real thing and every applicant should read it. How else are you going to know what Program Directors across the country are actually looking for in applicants to their specialty?
Lastly, we’ll talk about virtual interviews themselves. What are the pros/cons for you as the interviewee? What challenges exist for both you and the program interviewing you? How do you properly prepare for this different type of interview? How do you pre-emptively mitigate potential issues? And how do you create a solid virtual atmosphere to look like a boss and shine during the interview?

To pre-empt any confusion, the 2020 Match occurred in March 2020 and these applicants are now currently 2nd year residents (aka PGY2s). The overall Match rate was 81%. This was the highest rate since 1993, which is awesome. Doing a slightly more granular analysis, the match rate differed depending whether you were a current US student in an MD program vs DO program, already graduated from an MD or DO program, or an international student or graduate. For instance, the match rate for US students in MD programs was 94% vs. 90% for current US DO students vs. 61% for non-US international graduates. Overall – good chance of matching at baseline. Even more so, the overall match rate for couples was 95%. You gotta respect that a computer algorithm strives to keep lovers together. However, the rate of matching into one’s first choice program was only 43%, the lowest ever recorded. To me, this indicates that the most desirable programs have gotten even more competitive. Just the way it is. And all the more reason why it’s important to shine on these virtual interviews.

The most competitive specialties continue to be Plastic Surgery, Dermatology, ENT, Orthopaedic Surgery, Thoracic Surgery, Vascular Surgery, and Medicine-Pediatrics. The least competitive similarly didn't change much: Family Medicine, Internal Medicine, Pathology, Surgery Prelim, and Pediatrics. Competitiveness obviously has no bearing on how “good” or “important” a specialty is. These are just the numbers. Now specific to Ortho (which is of course the best and most important specialty), there were a total of 203 programs with 1192 applicants for 849 available PGY1 positions. This is actually an increase from 755 available positions in the prior year.

So that’s the recent Match data. Good to know the playing field. Regarding the Program Director (PD) Survey – this is conducted by NRMP every 2 years to survey Program Directors across the US in all specialties. In my opinion, the most useful information from this survey for applicants is two-fold: what factors are PDs looking at to offer interviews, and what factors are PDs looking at to rank applicants to Match. Overall across all specialties, the 5 most important factors to receiving an interview invite:

Step 1 score (still the most important thing until January 2022…when it becomes Pass/Fail)
Letters of Recommendation (LORs)
Step 2 score (once Step 1 becomes Pass/Fail…this is likely to be crowned as the most important factor)
Personal Statement
Dean’s Letter (also called the MSPE by some programs)

But that’s just to land an interview. Once you’re at that point, you are already a top applicant on paper. Now they need to make sure you aren’t a sociopath. So overall across all specialties, the 5 most important factors to being ranked to Match:

Interpersonal Skills
Faculty interactions during the interview/visit
Resident interactions during the interview/visit
Feedback from current residents
Letters of Recommendation

Notice how test scores and grades become far less important once you’ve already landed the interview. They only get you through the door. What gets you to Match is how you behave as a person. And this is precisely why this year is so tough for applicants and programs alike – virtual interviewing, lack of away rotations, lack of site visits…makes it really hard. Stay tuned – I’ll go over all the tips and guidance to be a stellar virtual interviewee below.

Relating to Ortho, the 5 most important factors to getting an interview:

Step 1 score (no surprise)
Letters of Recommendation
Performance during Orthopaedic Surgery elective and away rotations
Evidence of Professionalism and Ethics
Class Rank and Step 2 score (tied)

Obviously, number 3 is curtailed for applicants this cycle. You have the Ortho elective rotation at your home program, but for the most part no away rotations this year. This places an incredible amount of importance on your home Ortho rotation. You have to absolutely dominate and be a top student. There’s no excuse for not being prepared, showing up on time, reading for the cases, being proactive and helping however you can, etc. You know the drill. If you’ve forgotten, refer to the prior dedicated post. Regarding Professionalism and Ethics…this really comes from how your LOR writers describe you, what your Dean’s Letter says about you, lack of any egregious complaints, and potential awards you’ve won in this area. There’s not really anything specific you should do to be “professional or ethical”…just be a good person (and if that’s hard for you…please leave my website and pick another career). Now to get ranked to Match for Ortho, the 5 most important factors:

Faculty interactions during the interview/visit
Feedback from current residents
Resident interactions during the interview/visit
Interpersonal Skills
Leadership Qualities

Again just like the 5 top factors for all specialties overall, these largely stem from your interactions. Grades/scores are absent here. So enough about how important interpersonal interactions are. That’s obvious. Time to dive into tangible action items for doing well in your virtual residency interview.

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Before you wallow in the sorrow of self-pity and the unfairness of it all, take a step back. Breathe. It’s not all bad. There are certainly some positive aspects to virtual interviews:

Cost. On average, residency applicants can expect to spend between $2000 - $5000 on the entire process. Application fees, flights, lodging, Uber/car rental, food, etc. I personally spent around $4000. So the virtual mandate is nice to a medical student’s already suspect bank balance.
Time. Virtual interviews save a lot of time. You really just need to budget an hour or two for these, avoiding the headache of multiple airport trips, multiple Uber back seats, multiple lobbies of old medical buildings, etc. You also won’t miss as much time during a medical school rotation…after all you’re still paying for the tuition to get educated. Additionally, you don’t have to potentially miss family events or obligations, extra-curricular activities, etc. Leaving for an entire weekend for interviews is a big chunk of time. But an hour or two on a Saturday morning isn’t bad.
Breadth. You can apply much more broadly. Think about it rationally. You are saving so much money and there is far less chance of conflict for travel between interview dates/times. Even though Program Directors will hate this, I strongly recommend that all applicants apply far more broadly this cycle. In all honesty, I would personally do exactly that. You have to do what’s best for your future, and you better believe that other applicants are doing this too. Quite a few medical students I’ve spoken with flat out stated that they plan to apply to every single program in their preferred specialty. Apply as broadly as possible to give yourself the best chance of Matching. You don’t want to be caught on the wrong side of applying too conservatively when everyone else is going hard in the paint. More applications = more potential interviews = higher chance of Matching. And like anything in life, the more virtual interviews you do, the better you get at it.

There are of course definite downsides to virtual interviews, several of which we’ve touched on already.

Interaction. Needless to say, you lose something in relatability to another person when you’re just staring at their pixelated face and torso. This is major dilemma not only for you as the applicant trying to look good, but also for you to gauge the culture and “fit” of the program. Remember…interviews are not one-way streets. You are still assessing the program just as much as they are assessing you. You’re potentially going to spend 3-7 years with these people, and it’s crucial that you like the culture, camaraderie, program values, and the complement of residents. This is very challenging to assess in a 30 minute glorified version of FaceTime.
Competition. Just like with “Breadth” above, every applicant is going to shotgun their application everywhere. So the shear number of applications that Programs will receive is going to be tremendous. It’s simply a numbers game – more applicants for limited residency spots will increase the competitiveness for all.

There are general challenges of virtual interviews for both applicants and programs. The modern colloquialism of “Zoom-fatigue” is real. As everyone by now can attest, doing multiple virtual conferences gets very dull, boring, and energy sapping. This is natural, and will affect both you and those interviewing you. Consider that the interviewers are likely doing 20-30 virtual interviews that same day. Far more than you. Their enthusiasm and energy level will likely be precipitously low as the day drags on. Furthermore, Internet and app connectivity issues are seemingly inexorable. It’s bound to happen at some point, whether your audio cuts out, some interviewer’s phone keeps ringing and they can’t figure out how to click the mute button, the app on your laptop crashes, whatever.

Now we’ll get into the real crux of it. How to ensure an excellent virtual interaction with a program. I’m using the term “interaction” instead of “interview” on purpose. Think of this entire process not solely as the single 30-minute virtual interview with that program. It is a series of interactions, each of which plays a factor. It begins before the actual interview, and I’ll break it down into 3 stages:

Pre-interview
The Virtual Interview Itself
Post-interview

Pre-Interview. Many programs across the country in all specialties are hosting virtual socials and Q&A sessions, to provide more info about their program, answer any pressing questions, and create a venue for interaction with applicants. This is a great opportunity for applicants, and I highly recommend that you attend multiple. My Orthopaedic Surgery program that I trained at similarly hosted several of these. As an applicant, this is the next best thing to actually interacting with the faculty and residents in person. It’s not by any means perfect, but it’s the best you’ve got. You can gain insight into the program structure, ask questions and listen to other applicants’ questions, and get some feel for program “fit” and culture. And from a purely realistic standpoint – programs will keep track of which applicants attended the virtual sessions as a gauge of interest. So it would behoove you to attend at least those sessions for programs you are particularly interested in.

In addition to simply attending the sessions, I recommend obtaining contact info for several current residents at the program. This allows you to ask questions “off the record”, or inquire about things you may shy away from asking during the larger group meeting. It further affords you the opportunity to build continued rapport with several residents at the program. This will lend additional insight into the type of residents at that place, how they get along, collegiality with attendings, rotation structure, what changes they would like to see, if it’s a surgical specialty then how the operative experience and autonomy are, etc.

In this same vein, reach out to any current residents you may know in this specialty. People a couple years ahead of you in medical school? Email or text them. Some resident you worked with on a research project? Reach out. Someone you’re friends with on Facebook or Instagram? Slide into those DMs! Seriously, with the lack of in-person ability for you to evaluate programs, your best bet is to get insight from people already in those positions. And get multiple sources to curate consistency of opinion. Even in normal application cycles, you can’t possibly glean everything of value from a single interview day that lasts a few hours. A lot of it depends on communication and advice from people that have gone through it before. So hit them up!

Preparation is key. Once you receive interview invitations, it is absolutely imperative that you confirm exactly what software the virtual interview will take place on, and the time (and time zone). Even during standard in-person interviews, there are always one or two applicants each cycle that inevitably go to the wrong address or show up at the wrong time. You don’t want to scramble to download a random conferencing application at the last minute, or log in from California thinking it was scheduled at 9:00am forgetting it’s an East Coast program and they meant Eastern Time Zone. Don’t be that person. Email the program coordinator to confirm the app being used and time/time zone.

Rehearsal is mandatory. Why do pro athletes practice? Why are political speeches rehearsed? Why do stand-up comedians test their bits at small local joints before a grand performance? Because practice truly makes perfect. So have your roommate, spouse, sibling, parent, mentor do a practice interview with you. And make them give you real critique. Not just regarding your answers to questions…your posture, delivery, eye contact, and especially the first impression they get when they see you and the atmosphere around you on the screen. This last part is huge. You may think you have a “cool” or “badass” set-up. But your opinion of “badass” may not be shared by an interviewer several decades removed from you when he/she sees your collection of wall art. Make sure the environment around you, the lighting, the background, etc is optimized. The interviewers’ attention should be on you. Not on your prized Teletubbies poster on the wall behind you.

Research the program exhaustively. If you are half-assing it…you don’t deserve to match there. That applies to virtual just as it does to in-person interviews. You should know everything about the program structure, rotations, call schedule, team-based rotations versus mentorship model (or mixed), academic vs private vs mixed setting, types of facilities, operative experience (for surgical specialties), etc. If there are questions you don’t have answered come interview time…then ask. Medical students often ask me:

What kinds of questions are good questions?
What questions should I ask on interviews?
How can I appear genuinely interested?

The entire premise of this is misplaced. Don’t ask questions just to “seem” interested. You really should be interested! And the only way you will actually know if a program interests you is to research it ahead of time. Figure out what kind of education and training you will receive at this place. Only then can you ask meaningful questions and receive fruitful answers.

The Virtual Interview Itself. Just like you would with an in-person interview, be ready early. Virtual doesn’t mean you just hop onto your laptop at the nick of time. Be early. Get ready and dressed just like you would in person. Don't be the person wearing a logo-emblazoned T-shirt or a golfing Polo. Seriously. Just wear business casual attire. Your wardrobe is not what you want people to remember about you. And it seems ridiculous that I even have to mention this…but please wear pants. Don’t be the person with a button down and suit jacket on…only to stand up with the video rolling, forgetting that they thought pants weren’t necessary. Just put the damn pants on.

Next run through the 12 Item Virtual Checklist:

Laptop/computer battery is full, charging cable works
Internet connection works (this is why you wake up early…have a backup location, like a trusted friend’s apartment or nearby library with individual study rooms)
Area is clean and appropriate with functional lighting (you should already know exactly where you’ll sit for the interview based on your rehearsals)
Switch off your phone (one year an applicant forgot to put his phone on silent…let me tell you, as a personal aficionado of late 90s/early 2000s rap, hearing the angelic voice of Lil Jon enunciating the ballad of “Get Low” is always awesome…except if you’re sitting in the interview chair hoping to land a spot in a residency program…as much as we love Mr Jon…please switch to silent)
Login in with a professional username (hopefully you’ll be smart enough to simply use your full real name, and please don’t be the person using their old middle school Hotmail account…it’s no longer “cool” to have cartoon character names in your email)
Avoid any seemingly “cute” backgrounds that come pre-installed with the myriad of video conferencing apps like Zoom (save the puppy filter for Google Hangouts with the in-laws next weekend)
Sit up straight (please don’t lean towards the camera on your laptop)
Don’t fidget or rock back and forth (very distracting)
Look directly into the camera, not your own face in the smaller split screen box at the bottom (it’s very tempting, but do your best to maintain solid eye contact with the camera…this is why you’ve got to practice)
Don’t eat during the virtual interview or even prior Q&A sessions (this seems obvious…but with so many virtual conferences over the past few months, inevitably there is someone who thinks their audio is off and they go to town on some unnecessarily crunchy food…by now I’m able to discern the subtle yet ever-present decibel difference between Doritos and Cheetos…so yeah…don’t eat during the interview or prior socials)
Have pen/paper next to you (use everything to your advantage…have a cheat sheet with quick reference info specific to that program, short bullet points about research and activities you’ve been involved with, copy of your CV, and a list of questions you’d like to ask)
Speak clearly and calmly (virtual interviews are naturally more awkward than in-person, so our tendency is to try and get through them quickly…don’t succumb to this, remain confident and poised…you’re only moments away from success)

Ultimately you have to be flexible. Don’t get thrown off your game. The interviewers are people too, and just as likely to succumb to “Zoom fatigue” as you are…especially considering that they are virtually interviewing potentially 30+ applicants that day. They may look away, not maintain sustained eye contact, shuffle papers (your application file), check their phone (rude…but thus is life), etc. Don’t get flustered. Maintain your strong posture, eye contact, vocal cadence, and stay engaged. If you feel that the interviewers may be losing interest or turning more towards the papers in front of them and less towards you…might be a good time to sprinkle in a question or two. Change the dynamic from a one-sided soliloquy to a proper dialogue.

Post-Interview. Obtain the contact information of several faculty members that seemed engaged and interested. Do the same for some of the residents. Even though many programs in the past have discouraged post-interview communication, this year is quite different. With so many applicants applying more broadly than normal, it will be very difficult for programs to sift through the masses. If you are truly interested in a few programs, reach out to them. Nothing wrong with that. Simply convey your interest. And this is precisely why you keep in contact with a few residents and faculty at that program, because a string of continued rapport after the virtual interview will help confirm to the program that you are earnest in your expressed interest. It also allows you to follow up on questions that were not fully answered, or in the event that new information arises. For instance, if a program you were interested in reveals a large change after the interview is over…like a new Department Chair…it’s natural that you’ll want to know more about it. Additionally, you will gain a better understanding of the differences between program styles and the different types of training environments offered as you progress through the interview process. So it’s very reasonable that you’d like to return to a prior program and ask different or additional questions. Keeping an open stream of communication will never hurt you.

Yeah…that was a lengthy post. But it’s a big topic and important enough to really spend some time on. I hope it’s given you a solid grasp of the general landscape surrounding the Match, what the stats are, and what Program Directors are looking for across the board and also specific to Ortho. I further hope that I’ve shed light on the virtual process with its pros and cons, allayed some fears, and offered meaningful guidance on how to best prepare and thrive in this strange new normal that we find ourselves living in.

Best of luck as you traverse the virtual Match! As always, feel free to reach out if you have any additional questions or concerns.