The Carbon Footprint of Residency Interview Travel

The Climate Impact of Medical Residency Interview Travel in the United States and Canada: A Scoping Review

Background The change from in-person to virtual interviews for graduate medical education (GME) provides the opportunity to compare the potential environmental effects. Objective To explore and summarize the existing literature on the potential climate impact of medical residency interview travel through a scoping review. Methods The search was conducted in October 2022 using 5 research databases. Results were screened for inclusion by 2 reviewers in a 2-tiered process. Inclusion criteria were limited to English language articles from the United States and Canada, with no limitations on the type of study, type of applicant (allopathic, osteopathic, or international medical graduate), or type of residency. A thematic analysis focusing on the objectives and main findings of identified studies was conducted and an iteratively created standardized data extraction worksheet was used such that all studies were explicitly assessed for the presence of the same themes. Results The search identified 1480 unique articles, of which 16 passed title and abstract screening and 13 were ultimately included following full-text review. There were 3 main themes identified: the carbon footprint of residency travel, stakeholders' perspectives on virtual interviews, and advocacy for virtual interviews. All 13 articles employed persuasive language on interview reform, ranging from neutral to strongly in favor of virtual interviews based wholly or in part on environmental concerns. Conclusions Two main findings were identified: (1) Though carbon footprint estimates for in-person interviews vary, in-person interviews create considerable carbon emissions and (2) those working in GME are concerned about the climate effects of GME practices and describe them as a compelling reason to permanently adopt virtual interviewing.

Multicenter Study of Optional In-Person Visits to Residency Programs After Virtual Interviews

Background Compared to in-person recruitment, virtual interviewing reduces costs and promotes equity. However, many residency applicants believe that visiting programs helps inform their rank decisions. Objective We assessed the feasibility of and stakeholder opinions about optional in-person visits after virtual interviewing and program rank list finalization. Methods Six internal medicine residency programs conducted virtual recruitment in 2022-2023 and finalized their rank lists 4 weeks before the deadline. Applicants were invited for optional in-person visits after program rank list finalization. Interviewed applicants, program directors, and program administrators were given surveys that included 7-17 questions and employed "skip logic," discrete answers (eg, "yes/no/unsure" or multiple choice), and open-ended questions. Survey questions assessed stakeholders' opinions about the value, equity, and potential downsides of this recruitment process. Results Participating programs interviewed an average of 379 applicants (range 205-534) with 39 (10.3% [39 of 379], range 7.9%-12.8% [33 of 420-51 of 397]) applicants completing in-person visits. Of 1808 interviewed applicants, 464 responded to the survey (26%); 88% (407 of 464) believe a similar optional in-person visit should be offered next year, 75% (347 of 464) found this process equitable, but only 56% (258 of 464) trusted programs not to change their rank lists. Nearly all who attended an in-person visit (96.5%, 109 of 113) found it valuable. All program directors liked the optional in-person visit and believe future applicants should be offered similar in-person visits. Conclusions A large majority of participating applicants and program directors believe that in-person visits should be offered after program rank list finalization. The majority of respondents felt this recruitment process was equitable.

High acceptability, convenience and reduced carbon emissions of tele-neurology outpatient services at a regional referral centre in Kenya

Background

There is severe shortage of neurologists in sub-Saharan Africa. Tele-neurology consultations (TNC) can bridge this service gap, but there is very little published evidence on TNC in our setting, which we addressed through our study.

Methods

We prospectively enrolled patients at our neurology outpatients from October 2020 to October 2021. We administered a post-TNC questionnaire which captured satisfaction/acceptability using Likert scales. A sub-group of participants who also did in-person consultations (IPC) were additionally administered post-IPC questionnaires. Statistical comparisons were made using the paired student t-test, and descriptive data expressed as median (inter-quartile range).

Results

From 219 enrolled patients, 66.7% participants responded: 74.0% had both IPC and TNC; 63.0% were female; age was 40.9 (30.6-55.2) years; and 2.7% were from neighbouring countries. The commonest presentations were headache (30.8%), seizures (26.0%) and neurodegenerative disorders (15.1%). For TNC, >90% found it: (i) as comfortable as IPC (p = 0.35); (ii) didn't violate their privacy; (iii) saved time [3.0 (2.0-4.0) hours], travel [11.0 (7.2-21.1) km] and cost [$9.09 (4.55-18.18)]; and (iv) addressed their concerns satisfactorily such that they would use TNC again. Conversely, 15.1% didn't agree with TNC being as effective as IPC, and felt the neurologist did not satisfactorily identify all of their health problems (p = 0.03). In total, our TNC service saved our patients $6167, 1143 h, and 25,506 km of travel, translating to 3.5 t (equivalent to 21 newly-planted trees) of carbon dioxide emissions.

Conclusions

Our study demonstrates that TNC is an acceptable, efficient, effective, and environmentally-sustainable care delivery model.

Intern Experience Reflects Information Gathered During the Virtual Interview Process

OBJECTIVE

The onset of the coronavirus 2019 (COVID-19) pandemic brought many changes to the residency application process including transitioning to a virtual interview platform, which continues today. The transition brought many concerns from general surgery applicants about their ability to obtain adequate information about a program virtually. We sought to characterize how information presented by programs during the first ever virtual interview cycle matched the experience of general surgery interns after training at a program for 1 year.

DESIGN, SETTING, AND PARTICIPANTS

In May of 2022, a survey was distributed to 243 program directors who were asked to forward it to their general surgery categorical interns who matched during the 2021 virtual match cycle. Demographics, resources used to determine an impression of a program, and correlations between information presented virtually and what was subsequently experienced as an intern were collected.

RESULTS

Forty-six program directors confirmed forwarding the survey to their categorical interns. A total of 102 general surgery interns completed the survey. Most interns (88.2%) agreed that their experience matched expectations based on information received through the virtual interview process and 98% of interns were satisfied with their experience at their training program. Interviews with faculty (40.0%), residents (68.0%) and the program web site (29.0%) were the top 3 resources used to create the most accurate impression of a program. Interns felt they were well informed during the virtual interview experience about support from fellow residents (84.3%), culture (73.0%), surgical volume (72.5%), and intern operative experience (71.6%). In addition, 65.7% of participants thought they were able to obtain a good understanding of the program's culture from the virtual process. However, 16.7% thought that their program unintentionally misrepresented aspects of the training program.

CONCLUSIONS

The faculty and residency interviews were the most important factors in program ranking and most participants agreed that their virtual interview experience matched their expectations during their intern year. Most interns felt they were able to obtain a good understanding of the program's culture from the virtual process. In addition, a majority of interns felt well informed during the interview on aspects ranging from surgical volume, autonomy, and work hours to support from faculty and residents. If virtual interviews are to continue, residents can be satisfied that information gathered virtually will match the reality of their training. Programs should continue to make every effort to present their program realistically.

Ethical Considerations of Climate Justice and International Air Travel in Short-Term Electives in Global Health

In July 2022, the American Society of Tropical Medicine and Hygiene Green Task Force advocated to acknowledge the health impacts of climate change, particularly on those in low- and middle-income countries, and called on global health organizations to act. Simultaneously, academic medical centers are resuming Short-Term Electives in Global Health (STEGH) as travel restrictions imposed during the COVID-19 pandemic ease in most countries. International flights by trainees from academic medical centers in high-income countries (HIC) on these electives encapsulate the climate injustice of who generates carbon emissions and who bears the impacts of climate change. Using "decolonization" and "decarbonization" as guiding principles, we suggest several strategies that global medical education programs in HIC could implement. First, restructure rotations to halt STEGH with minimal benefit to host institutions, optimize trainee activities while abroad, and lengthen rotation duration. Second, programs can calculate the carbon impact of their STEGH and implement concrete measures to cut emissions. Finally, we urge academic medical centers to promote climate-resilient healthcare infrastructure in host countries and advocate for climate solutions on the global stage.

Evaluation of sleep medicine fellowship program websites

STUDY OBJECTIVES

Sleep fellowship program websites likely serve as a preliminary source of information for prospective fellows. Arguably, applicants have likely become even more reliant on program websites during the COVID-19 pandemic due to travel restrictions and social-distancing measures limiting in-person interviews. In this study, we evaluated the content and comprehensiveness of sleep medicine fellowship websites to identify areas of improvement.

METHODS

A list of sleep medicine fellowship programs in the United States participating in the 2021 match cycle was compiled using the Electronic Residency Application Service (ERAS) and Fellowship and Residency Electronic Interactive database (FREIDA) websites. Twenty-two prespecified content criteria related to education, recruitment, and compensation were used to evaluate each program website. Sleep programs' website comprehensiveness were compared based on US location, type, matching status, core specialty, and size of programs.

RESULTS

Seventy-eight US sleep fellowship program websites were evaluated. Most program websites had a working hyperlink on ERAS or FREIDA. There was considerable variability in content reported across program websites, with a mean of 56.8% of content items reported per program. There was a greater educational website content comprehensiveness for internal medicine compared with other specialty-based sleep programs. There was no difference in sleep programs' website comprehensiveness based on US location, type, matching status, or size of programs.

CONCLUSIONS

Website content comprehensiveness among sleep fellowship programs is variable. There is opportunity for all sleep fellowship programs to improve their websites to better inform prospective trainees.

CITATION

Shenoy S, Akberzie W, Landeo-Gutierrez JS, Leon Guerrero CR, Karroum EG. Evaluation of sleep medicine fellowship program websites. J Clin Sleep Med. 2023;19(6):1083-1088.

Interview Without Harm: Reimagining Medical Training's Financially and Environmentally Costly Interview Practices

The looming threat of climate change urgently calls for reimagining unsustainable systems and practices, including academia's culture of emissions-intensive travel. Given that medical educators are uniquely invested in the future of the trainees they represent, this reimagination can and should begin with medical education. Making significant reforms to the application process has historically been challenging, but the COVID-19 pandemic catalyzed an abrupt shift from in-person to virtual interviews for medical school, residency, and fellowship. Programs and applicants alike demonstrated resilience, innovation, and satisfaction in adapting to virtual interviews during 2 full application cycles. This restructuring has prompted consideration of the necessity of environmentally costly, expensive, and time-consuming cross-country travel for single-day interviews. However, evolving conversations about the future of medical training interviews have not prioritized environmental impact, despite the sizeable historical emissions generated by interview-related travel and the incompatibility between ecological damage and population health. Beyond environmental impact, virtual interviews are more equitable, with significantly fewer financial costs, and they are more efficient, requiring less time off from school or work. Many concerns associated with virtual interviews, including interview inflation and limited applicant exposure to programs and their surrounding areas, can be addressed via creative and structural solutions, such as interview caps and in-person second-look programs. The medical training interview process underwent a forced restructuring due to the unprecedented disruption caused by COVID-19. This moment presents a strategic inflection point for medical education leadership to build on the momentum and permanently transform the process by focusing on sustainability and equity.

The Carbon Footprint and Cost of Virtual Residency Interviews

BACKGROUND

The shift from in-person to virtual residency interviews may impact greenhouse gas emissions (GHGE) and costs but the direction and amount of this change is not yet clear.

OBJECTIVE

To estimate GHGE and financial impacts of virtual interviews among applicants and programs.

METHODS

In 2020-2021 we sent a postinterview survey to 1429 applicants from 7 residency programs and 1 clinical psychology program at 1 institution. The survey collected origin of travel and transit type if in-person interviews had been held and excluded responses if the applicant would not have participated in an in-person interview, or if travel type or original city was missing. We used the International Civil Aviation Organization calculator to estimate flight-related GHGE in metric tons of carbon dioxide equivalent (MTCO2e) and Google Maps to estimate ground travel, with a standard CO2e per mile. Flight, hotel, and airport taxi costs were estimated using Expedia.com, Hotels.com, Uber, and Lyft. We aggregated these data and calculated median and interquartile ranges (IQRs) for applicant GHGE and cost savings, and assumed no cost or GHGE from virtual interviews. We used Wilcoxon signed rank sum tests to compare in-person 2019-2020 and virtual 2020-2021 GME program interview budgets.

RESULTS

The survey response rate was 565, or 40% of applicants; 543 remained after the exclusion criteria were applied. Reduction in applicant travel due to virtual interviews led to median estimated GHGE savings of 0.47 (IQR 0.30-0.61) MTCO2e and $490 (IQR $392-$544) per applicant, per interview. Programs savings ranged from $7,615 to $33,670 for the interview season.

CONCLUSIONS

Virtual interviews in 8 GME programs were associated with lower estimated GHGE and costs, for applicants and programs, compared with in-person interviews.

Pediatric Otolaryngology fellowship virtual interview sentiments

BACKGROUND

Interviews for Pediatric Otolaryngology fellowship rapidly transitioned to virtual interviews mid-cycle in March 2020 due to the COVID-19 pandemic.

OBJECTIVE

This study aims to describe perspectives on virtual versus in-person interviews for both applicants and program directors.

METHODS

Cross-sectional study. Surveys were conducted of all Pediatric Otolaryngology fellowship applicants participating in the San Francisco Match and program directors in 2020 and 2021.

RESULTS

Out of 32 U.S. trained fellowship applicants, 24 completed the survey in 2020 and 18 in 2021. While 70% of applicants felt they did not get the same experience with virtual interviews, 75% did not feel it changed how they ranked programs. Applicant perception of virtual interviews improved in 2021, with the majority (56%) preferring virtual interviews if provided an option. Twenty out of 36 fellowship directors completed the survey in 2020, and eighteen in 2021. While fellowship directors continued to prefer in-person in 2021, an increased number (10% in 2020, 30% in 2021) felt continuing with virtual interviews may increase the number of applicants in the future.

CONCLUSION

Based on the survey, both applicants and fellowship directors had a less favorable perception of virtual interviews compared to in-person interviews initially; however, applicant perception favored virtual interviews in 2021, while Program Directors continued to prefer in-person.

Virtual residency recruitment: future directions in the new era

INTRODUCTION

The COVID-19 pandemic led to many changes in healthcare including graduate medical education (GME). Residency and fellowship programs halted in-person recruitment and pivoted to virtual models. Residency selection and recruitment were practices ripe for redesign, as they relied on in-person interviewing as the major point of contact prior to match list creation. In this commentary, we review the state of virtual interviewing and propose a future state where virtual interactions are commonplace and integrated into a comprehensive recruitment process.

DISCUSSION

Virtual recruitment has led to a reduction of expenses, improved time efficiency for all parties and a reduced carbon footprint. Residency match outcomes have not changed substantially with the advent of virtual interviewing. Hybrid approaches, including virtual and in-person options have significant drawbacks and pitfalls which may limit adoption. Given the upheaval in GME recruitment caused by the pandemic, and the limitations of current methods for candidate assessment and interactions with programs, further innovation is needed to achieve an optimal state for all stakeholders. Multiple technology innovations are on the horizon which may improve the ability to interact virtually. Adoption of new technology along with expanding the timeline for residency recruitment may further optimize the process for both applicants and programs.

CONCLUSIONS

The GME community was able to adopt technology for the recruitment interview rapidly due to the pandemic. As more opportunities for technology-based interactions grow, the opportunity exists to reimagine recruitment beyond the interview. While resources are constrained, some of the efficiencies gained by adopting virtual interviewing can be leveraged to expand the interactions between programs and applicants. Incorporation of in-person interaction may still be needed. Models will need to be developed to build upon the best characteristics of the virtual and in-person environments to optimize GME recruitment.KEY MESSAGES:Virtual communication methods have substantially changed residency recruitment during the COVID -19 pandemic.COVID -19 related changes in residency recruitment, including wide adoption of virtual methods, should be maintained and strengthened.Efforts should be made to advance the gains in residency recruitment strategy during the pandemic by use of technologies that expand virtual interactions beyond the interview.

Virtual interviewing for graduate medical education recruitment and selection: A BEME systematic review: BEME Guide No. 80

BACKGROUND

The COVID-19 pandemic caused graduate medical education (GME) programs to pivot to virtual interviews (VIs) for recruitment and selection. This systematic review synthesizes the rapidly expanding evidence base on VIs, providing insights into preferred formats, strengths, and weaknesses.

METHODS

PubMed/MEDLINE, Scopus, ERIC, PsycINFO, MedEdPublish, and Google Scholar were searched from 1 January 2012 to 21 February 2022. Two authors independently screened titles, abstracts, full texts, performed data extraction, and assessed risk of bias using the Medical Education Research Quality Instrument. Findings were reported according to Best Evidence in Medical Education guidance.

RESULTS

One hundred ten studies were included. The majority (97%) were from North America. Fourteen were conducted before COVID-19 and 96 during the pandemic. Studies involved both medical students applying to residencies (61%) and residents applying to fellowships (39%). Surgical specialties were more represented than other specialties. Applicants preferred VI days that lasted 4-6 h, with three to five individual interviews (15-20 min each), with virtual tours and opportunities to connect with current faculty and trainees. Satisfaction with VIs was high, though both applicants and programs found VIs inferior to in-person interviews for assessing 'fit.' Confidence in ranking applicants and programs was decreased. Stakeholders universally noted significant cost and time savings with VIs, as well as equity gains and reduced carbon footprint due to eliminating travel.

CONCLUSIONS

The use of VIs for GME recruitment and selection has accelerated rapidly. The findings of this review offer early insights that can guide future practice, policy, and research.

Should Radiology Residency Interviews Remain Virtual? Results of a Multi-institutional Survey Inform the Debate

RATIONALE AND OBJECTIVES

The recent completion of the inaugural virtual interview season has triggered calls for the permanency of virtual interviews in the radiology resident selection process. We designed a study to assess the inaugural 2020-2021 virtual interview season and inform the anticipated debate on the future of radiology residency interviews.

MATERIALS AND METHODS

Forty-four and 39-question survey instruments developed for program directors (PDs) and applicants, respectively, were distributed through the Radiology Residency Education Research Alliance to measure the demographics, experiences with technology, attitudes toward the virtual interview season and attitudes about proposed changes to the interview process. Comparisons were made between demographics and survey queries.

RESULTS

PD and applicant response rates were 74% (25/34) and 45% (84/186), respectively. Eighty percent (20/25) of PDs and 76% (64/84) of applicants described the virtual interview season as excellent or very good. Sixty percent of PDs agreed or strongly agreed with the statement "The benefits of the virtual interview season outweighed the drawbacks," while 24% disagreed or strongly disagreed, and 16% were neutral. Among applicants, 80% agreed or strongly agreed, 10% disagreed or strongly disagreed, and 10% were neutral toward the same statement. Ninety-two percent of PDs noted that their rank order list performed the same or better than in years prior. Both PDs and applicants identified applicant equity and wellness as major benefits of virtual interviews, while identifying over-application and interview hoarding as significant detriments.

CONCLUSION

The virtual interview provides an adequate substitute for the conventional in-person residency interview, with real and perceived benefits to applicant wellness, equity, and financial well-being. The downsides of virtual interviews, namely over-application and interview hoarding, have workable solutions.

Distributions of Residency Interviews With the Implementation of Virtual Interviews and Standardization of Interview Offer Dates

OBJECTIVE

Virtual interviews were widely implemented alongside many other changes in the 2021 residency application process. We investigated how these many interventions may have influenced interview distributions and completions.

DESIGN

Cross-sectional survey distributed electronically to obstetrics and gynecology (OBGYN) residency applicants in February 2021. Distributions of interview invitations, interviews completed, and percent of interview offers completed were compared to the previous application cycle. The odds ratios of receiving interviews were calculated based on applicant characteristics including test scores, number of applications, and race/ethnicity.

SETTING

All OBGYN residency applicants registered through the Electronic Residency Application Service.

PARTICIPANTS

The 915 (36%) of 2577 total OBGYN applicants who responded to the survey.

RESULTS

US allopathic medical students received fewer interview offers in 2021 (median 13 [interquartile range 9-19]) compared to 2020 (median 15 [interquartile range 11-20]). There was no difference in the absolute numbers of interviews completed. A United States Medical Licensing Exam Step 1 score ≥221 resulted in more than a five-fold increase in adjusted odds of receiving at least 12 interviews for allopathic students. Black or African American US allopathic seniors had a 2.3 odds ratio for receiving at least 12 interview invitations compared to White non-Hispanic or Latino US allopathic seniors, adjusted for Step 1 score and the number of programs applied to. Interview offers released on standardized dates had a mitigating effect on completing more interviews among allopathic seniors with at least 12 interview invitations.

CONCLUSIONS

Virtual interviews did not change the overall number of interviews completed. Standardization of interview offer dates mitigated excessive virtual interviewing, yet additional measures are needed to curb interview inflation and the effects on interview distributions.

Quantifying the climate benefits of a virtual versus an in-person format for an international conference

BACKGROUND

Academic institutions across the globe routinely sponsor large conferences. During the COVID-19 pandemic, many conferences have used all- or partially virtual formats. The conversion of the 2021 Consortium of Universities for Global Health (CUGH) conference, originally planned in-person for Houston, TX USA to an all-virtual format provided an opportunity to quantify the climate-related impacts of in-person versus virtual conferences.

METHODS

From the 2021 CUGH conference registration data, we determined each registrant's distance from Houston. Using widely available, open-source formulas, we calculated the carbon footprint of each registrant's round-trip drive or flight had they traveled to Houston. We assumed that registrants traveling more than 300 miles would have flown, with the remainder traveling by automobile.

RESULTS

Of 1909 registrants, 1447 would have traveled less than 4000 miles, and 389 would have traveled more than 10,000 miles round trip. Total travel-related carbon emissions were estimated at 2436 metric tons of CO₂, equivalent to the conservation of 2994 acres of forest for a year.

CONCLUSIONS

Organizations can now readily quantify the climate cost of annual conferences. CUGH's annual international conference, when held in-person, contributes significantly to carbon emissions. With its focus on promoting global health equity, CUGH may play a lead role in understanding the pros and cons for planetary health of in-person versus virtual conferences. CUGH and other organizations could routinely measure and publish the climate costs of their annual conferences.

Adapting to the Era of Virtual Recruitment: Radiology Departmental Website Response to COVID-19 and Portrayal of the Resident Experience

Rationale and Objectives

The COVID-19 pandemic has transformed radiology recruitment into a virtual affair and placed an even stronger emphasis on the importance of departmental websites. In this study, we evaluate residency websites in detailing the response to COVID-19 as well as initiatives which help describe the resident experience.

Materials and Methods

Program websites for diagnostic radiology residencies listed in the 2022 Electronic Residency Application Service (ERAS) program list were evaluated for 31 criteria related to departmental response to COVID-19, online outreach, and resident wellness.

Results

Of 184 programs, 182 had functioning websites for review. One program was excluded from analysis as the website was almost entirely video-based. In response to COVID-19, ≤1% described resident redeployment, vaccination information, departmental response to ABR Core Exam changes, or regular administration updates. Six (3.3%) described revised read-out protocols, four (2.2%) mentioned supplementary non-clinical education, and 14 (7.7%) indicated changes to educational conferences. The majority of websites (122, 67.4%) offered an informational or tour video, while 44 (24.3%) described expectations for virtual interviewing, and 20 (11.0%) had virtual “open-houses.” Departmental social media, primarily Twitter, was linked for 60 (33.1%) programs. A total of 134 (74.0%) websites described community highlights.

More than a quarter mentioned meal stipends (72, 39.8%), paid sick time (54, 29.8%) and healthcare resources (57, 31.5%). Although social activities were described by 44 (24.3%) programs, some specifically indicating changes to COVID-19, formal resident mentoring (25, 13.8%) and wellness committees (28, 15.5%) were less common. These criteria were found more commonly at the largest third of residency programs (chi square, p < 0.00625).

Conclusion

Programs rarely described work flow changes to COVID-19, and websites could improve in virtual outreach. Compared with prior literature, departmental websites have improved in describing wellness initiatives and related measures.

The Virtual Interview Experience: Perspectives of Pulmonary and Critical Care Fellowship Applicants

Background

Because of the coronavirus disease (COVID-19) pandemic, graduate medical education programs adopted virtual interviews (VIs) as the default modality for the 2020 recruitment season. It is unknown whether VIs allowed applicants to effectively evaluate programs, and the best interview format for the future is unclear.

Objective

To 1) assess pulmonary and critical care applicants’ perceived ability to evaluate programs using VIs, 2) determine the attitudes of applicants toward the components of VIs, and 3) identify applicants’ preferences for the future fellowship interview format.

Methods

After the National Residency Matching Program medical subspecialty match, an electronic survey was sent to 1,067 applicants to pulmonary and critical care medicine programs asking them to compare their fellowship VI experience with their residency in-person interview (IPI) experience.

Results

Three hundred six (29%) applicants responded to the survey, and 289 completed it (27%). There were 117 (40%) women and 146 (51%) White individuals. Most respondents believed that VIs hindered their ability to evaluate programs’ culture, faculty–fellow relationships, location, facilities, and their own fit within the program. They believed they were able to evaluate the clinical experience, curriculum, and potential for academic development equally well compared with IPIs. The most helpful elements of VIs were the interview with the program director, meetings with the fellows, and interviews with faculty members. Less helpful elements included conference access, prerecorded program director presentations, virtual hospital and city tours, and video testimonials. One hundred twenty-three respondents (43%) chose VIs with an optional visit as their preferred future interview format, 85 (29%) chose IPIs, 54 (19%) wanted a choice between VIs and IPIs, and 27 (9%) chose VIs only.

Conclusion

Most pulmonary and critical care medicine applicants preferred future interviews to include both VIs and the option of an in-person visit or interview. This study can assist programs in designing their future interview formats in a trainee-centric fashion.

The Virtual Recruitment Onion: Peeling Back the Layers of the Interview Season During the COVID-era

OBJECTIVE

We sought to characterize General Surgery residency program directors' (PDs) baseline perspective on how the COVID-19 mandated changes to the recruitment and interview processes impacted how the PDs evaluated and recruited the applicants.

DESIGN

An anonymous cross-sectional questionnaire survey.

SETTING

A large, mid-western academic general surgery residency program.

PARTICIPANTS

47 PDs of Accreditation Council for Graduate Medical Education (ACGME) accredited General Surgery residency programs.

RESULTS

During the virtual-only interviews during the COVID-19 pandemic-era 2020-21 General Surgery residency application cycle, PDs shifted their focus to virtual outreach efforts and bolstered social media presences to recruit strong applicants. Also, our study found statistically significant changes to the increased value of letters of recommendation (LORs) for the PDs when assessing an applicant's commitment to surgery. These findings suggest that the necessity of adapting to the virtual-only interview format significantly altered how the PDs recruited and evaluated applicants for the General Surgery residency match.

CONCLUSIONS

A complete replacement of the in-person interviews with virtual-only interviews may be challenging unless buy-in exists from key stakeholders in the surgical community. Our study highlights the PDs' hesitation in assessing candidates' commitment to surgery from virtual interviews alone. Incorporating virtual interviews as a part of the screening process for applicants may serve as an avenue to maximize the benefits of the virtual interview format. Furthermore, COVID-19 pandemic has normalized the growing social media presence of residency programs, adding to the changing landscape of recruiting and interviewing applicants for General Surgery residency match.

A carbon footprint study of the Canadian medical residency interview tour

BACKGROUND

Each spring, thousands of Canadian medical students travel across the country to interview for residency positions, a process known as the CaRMS tour. Despite the large scale of travel, the CaRMS tour has received little environmental scrutiny.

PURPOSE

To estimate the national carbon footprint of flights associated with the CaRMS tour, as well as reductions in emissions achievable by transitioning to alternative models.

METHODS

We developed a three-question online commuter survey to collect the unique travel itineraries of applicants in the 2020 CaRMS tour. We calculated the emissions associated with all flights and modelled expected emissions for two alternative in-person interview models, and two virtual interview models.

RESULTS

We collected 960 responses out of 2943 applicants across all 17 Canadian medical schools. We calculated the carbon footprint of flights for the 2020 CaRMS as 4239 tCO₂e (tonnes of carbon dioxide equivalents), averaging 1.44 tCO₂e per applicant. The average applicant's tour emissions represent 35.1% of the average Canadian's annual household carbon footprint, and the emissions of 26.7% of respondents exceeded their entire annual '2050 carbon budget.' Centralized in-person interviews could reduce emissions by 13.7% to 74.7%, and virtual interviews by at least 98.4% to 99.9%.

CONCLUSIONS

Mandatory in-person residency interviews in Canada contribute significant emissions and reflect a culture of emissions-intensive practices. Considerable decarbonization of the CaRMS tour is possible, and transitioning to virtual interviews could eliminate the footprint almost entirely.

Residency interviews in the digital era

In the midst of the SARS-CoV-2 pandemic, the US Association of American Medical Colleges (AAMC) required residency programme transition from in-person to virtual interviews for all applicants. The new virtual format upended a system that has relied on programmes and applicants balancing the likelihood of acceptance with the financial and time demands of cross-country travel.In this commentary, we address the history of residency interviewing in the USA and the emerging changes that are taking place in light of virtual interviews. We discuss the advantages of the new online format, including the reduced cost for applicants and programmes, as well as the decreased carbon footprint.We also discuss the inequities of virtual interviewing, involving a national maldistribution of interviews to only the top-tier candidates. We share previously unpublished data on the number of virtual interviews accepted by Stanford's 2020 residency applicants, compared with those conducted in person in 2019. We find Stanford applicants in all fields accepted more interviews: from a mean of 8 in 2019 to 14 in 2020, a change of 160% on average. Despite this, only half of Stanford 2020 applicants interviewing in the virtual format thought they had accepted more interviews than they would have in person.We comment on how transitions to online interviewing may be affecting medical schools and applicants disproportionately. Ultimately, we highlight the need and offer ideas for additional regulation on behalf of the AAMC to ensure a more equitable distribution of interview opportunities.

National Pediatric Experience With Virtual Interviews: Lessons Learned and Future Recommendations

The coronavirus disease 2019 pandemic significantly impacted undergraduate and graduate medical education and created challenges that prevented a traditional approach to residency and fellowship recruitment and interviews. Early in the pandemic, the pediatric education community came together to support applicants and training programs and to foster an equitable recruitment process. We describe many of our community's innovations, including the use of virtual cafés to educate programs and highlight best practices for virtual recruitment and the use of regional webinars to highlight residency programs and provide information to applicants. Surveys of applicants and programs suggest that the virtual interview process worked well overall, with applicants and programs saving both time and money and programs maintaining a high rate of filling their positions. On the basis of this experience, we highlight the strengths and weaknesses of 3 potential models for future interview seasons. We close with a series of questions that need further investigation to create an effective and equitable recruitment process for the future.