AAIM Principles and Recommendations for the 2021-2022 Internal Medicine Residency Interview Cycle in Response to the Continued COVID-19 Pandemic

The COVID-19 pandemic has led to surges across the globe, with emerging variants and peaks at different times in different parts of the United States and internationally. Although vaccines have reduced infection rates in the United States, vaccine distribution varies among regions and worldwide. It is difficult, if not impossible, to predict which areas will experience a surge during the upcoming recruitment season. In 2020, many countries, states, cities, and institutions imposed strict travel restrictions and limits on group gatherings, and these restrictions may be repeated in 2021-2022. Consequently, some international medical graduates may not be able to travel to the United States during the pandemic; because international medical graduates are an essential part of the internal medicine physician workforce, it is critical to remove potential barriers to interviewing them for residency. To allow applicants and programs to plan ahead, AAIM recommends that all programs conduct their interviews virtually this season, including interviews of students matriculating, visiting, or rotating at their institution. This modification would also mitigate disparities among applicants in terms of access to travel (e.g., due to differences in travel restrictions between countries) and would allow all applicants to interview at the programs of their choice regardless of their location. In addition, virtual interviewing may help institutions achieve a reasonable balance between the time requirements of interview season and ongoing clinical demands, thereby helping to promote full faculty, resident, and student engagement in clinical rotations.

In 2021, there were 24,509 applicants to internal medicine residency programs, compared with 21,947 applicants in 2016.  In addition, the number of applications submitted per applicant increased from 57.8 in 2016 to 71.8 in 2021 and was up 11% from 2020. Medical school advisors should draw on their school's specialty-specific match data to estimate how many programs an individual student should apply to and interview with, while acknowledging the limitations of available data from last year. Drawing on the data from previous years would help advisors provide more specific guidance to students across the academic spectrum. In addition, creating a process to collect real-time data from students—and giving advisors access to this data—would allow them to provide individual recommendations to students about keeping or declining interviews, thus potentially opening up interviews for other applicants while ensuring that students have a sufficient number of interviews to secure a successful match.

The success of virtual interviews is dependent on many external variables, such as the quality of visual and audio equipment, a reliable internet connection, and access to a quiet, professional-appearing space that is free from distractions. Applicants with limited access to these resources are disadvantaged during virtual interviews and would benefit from having spaces provided for them by their school or institution. Medical schools can also provide students with a standard video conferencing background which could be used for all interviews.

Program directors and faculty interviewers have implicit and explicit biases that may be introduced or amplified when interviews are conducted through videoconferencing. Residency programs should require faculty interviewers to engage in education in identifying and mitigating bias in virtual interviews. This faculty development can be conducted through in-person training, online modules, or both. There are also general resources available for program leaders and faculty describing best practices for virtual interviewing.

Coaching on how to undergo a successful virtual interview should be provided by medical school advisors who are experienced in this area. Students should be directed to move the camera to eye level and to ensure optimal lighting and sound.  Advisors should also discuss virtual etiquette (e.g., how to interact when there are multiple applicants or faculty present on the call), how to enter and exit breakout rooms, and when to use the chat box or raised hand vs speaking out loud, depending on the situation.  Mock virtual interviews may be offered to students, with coaches paying attention to these details and giving feedback.  Advisors should also encourage students to make use of online resources that guide them through the virtual interview process.^,

Although the pandemic remains a threat to public safety at this time, rates of COVID-19 infection have decreased and vaccination rates have increased in many states in the United States. It is possible that interstate and even international travel may resume safely during the 2021-2022 interview season.  In that case, AAIM may issue an addendum to these recommendations, including consideration of optional in-person recruitment activities or second look visits. However, it is essential that programs apply the principle of equity in any future decisions about optional in-person visits.  It will also be important for programs to be transparent and to communicate clearly with applicants about the activities that are strictly optional and will not affect their rank on the rank list.