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This investigation found that the video interview platform for the 2020–2021 orthopedic surgery interview season was initially perceived as inferior to traditional in-person interviews by applicants, residents, and providers. However, after the interview season, perceptions generally improved and the favorable aspects of the video platform set a precedent for future interview seasons. Nevertheless, personal interviews were still strongly preferred by the vast majority of respondents.
Orthopedic surgery residencies place a high value on interpersonal interaction and fitting the individual into the program [23]. Therefore, it is not surprising that the initial favorability of video interviews was low in this study. Although the video platform provides a viable alternative to face-to-face interviews in the right situations, [3, 6, 13, 16,17,18,19] a number of concerns were clarified by the survey responses in this study. Most applicants were concerned about their ability to perform adequately with a video interview format and felt that they would not be able to gauge residency program culture well with video interviews compared to in-person interviews, which is consistent with previous literature [6, 20, 21]. Residents and faculty were similarly concerned about their ability to assess their fit using video interviews, a sentiment that significantly increased after the interviews were conducted.
A strong desire to find applicants who fit well with the culture of a given program is common to many majors. In orthopedics, this desire is exemplified by the extreme weight placed on visiting rotations that allow trainees and faculty members to assess a candidate’s noncognitive skills, such as the ability to develop interpersonal relationships, communicate, and function as a team member [24]. This is an integral part of both the program and the applicant to assess how compatible the applicant is with the program culture [23]. Compared to students who did zero visit rotations, Baldwin et al. found that students who participated in just two rotations abroad were 60 times more likely to join orthopedic surgery [24]. This is highlighted in the responses to the current survey, which found that 100% of residents and attendings were concerned that the lack of visit rotation would not allow the program to rank the best possible candidates. These findings illustrate the impact of personal interactions in selecting the most compatible candidates for future residency positions.
Prior to the pandemic, numerous programs and majors had already experimented with the video interview format with varying degrees of success. A study that randomized urology residency applicants to receive video or in-person interviews found that both applicants and faculty preferred the use of video interviews as an adjunct to in-person interviews, although the video interview format was generally perceived as less effective than traditional interviews [17]. Similarly, in a survey of gastroenterology fellowship applicants participating in both in-person and video interviews on the same day, 87% (14/16) supported offering video interviews as an option, and 81% (13/ 16) state that video interviews meet or exceed their expectations [13]. The Family Medicine Residency Program used video interviews as an applicant screening tool and found that a majority of interviewers and applicants believed that video interviews should be part of the application process; however, neither candidates nor interviewers believe that they should be the only means of interviewing [25]. Similarly, this study found that candidates were more receptive to a hybrid interview format and did not believe that in-person interviews were better for assessing culture and fit after the interview season was over. Additionally, residents and attendings were less concerned about the impact of video interviews on how applicants would rank their program and did not think in-person interviews were better than video interviews for rapport building. Although in-person interviews are still strongly preferred by the majority of respondents, these findings suggest that the 2020–2021 residency interview season may have increased acceptability for the future use of video interviews in the application process.
Several aspects of the video interview format were favorable among participants that deserve mention. Applicants reported that their financial burden of interviewing was significantly reduced compared to historical costs of in-person interviews, with over half of applicants reporting spending under $500 and the majority of applicants (80%) spending less from $2000. Compared to previous years, Fogel et al. reported an average of $7,119 among 43 orthopedic residency applicants [14]. Video interviews also save the program money and, on average, are perceived as more convenient among all groups. In terms of convenience, residents and faculty experienced fewer interruptions in the daily workflow, and medical students experienced fewer conflicts with clerkship schedules.
A potentially negative byproduct of this convenience and flexibility has led to more programs being applied to and interviewed, a topic of video interviewing that is common in the literature [3, 13, 14, 18]. Ease of electronic application submission was the initial catalyst for a dramatic increase in applicants across all majors, with some majors almost doubling their applications [26]. While video interviews potentially increase a candidate’s reach, it can come at a cost. Weisbart et al. found that applying to more programs did not improve match rates; rather, the authors suggest that it increased the selectivity and competitiveness of certain majors [27]. Therefore, it is possible that the already competitive field of orthopedic surgery will become even more so if video interviews are offered in the future.
There are several limitations to this study. Our investigation was conducted at a single institution and examined data over the course of a single application cycle. Despite our best efforts, the response rate to our email surveys never exceeded 60%, so the data presented are not representative of the entire applicant pool at our institution, nor of the entire faculty population in the Department of Orthopedic Surgery. Many students who responded to our surveys had never had in-person orthopedic surgery residency interviews in the past, so they had no baseline against which to compare their video interviews. Additionally, applicants to our institution are not representative of the entire orthopedic surgery residency applicant population in the United States, limiting the generalizability of our data.
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