COVID-19 has transformed the residency application process. Interviews are now virtual, many rotations have been canceled, and exams have been canceled or delayed. We conducted a survey to assess applicant concerns regarding interviews, letters of recommendation, anesthesiology rotations, and exams. Anesthesiology applicant concerns due to changes caused by COVID-19 and anonymous program director responses were collected and discussed on the Anesthesia and Critical Care Reviews and Commentary (ACCRAC) podcast.
The COVID-19 pandemic has altered clinical practice and daily life. It has also transformed the National Resident Matching Program (NRMP) residency application and Match process for medical students applying in anesthesiology. The Association of American Medical Colleges (AAMC) announced the recommendation for the implementation of virtual interviews for all residency programs and a delay of the Electronic Residency Application Service (ERAS) application timeline in Spring 2020. This recommendation, and its subsequent adoption by all specialties and the NRMP and ERAS, has had a profound impact on the planning for residency recruitment and the preparation for applications for both students and programs.
These changes to the residency application process have led fourth-year medical students applying in anesthesiology to have significant concerns around the requirements and submission of applications, virtual interview process, and ultimately, their chances for a successful result in the 2021 residency Match.
We created a survey that was distributed to fourth-year medical students applying in anesthesiology to assess their concerns and quantify the prevalence of these concerns. The results were then de-identified and presented to anesthesiology residency program directors who provided their insight. Applicant concerns and program director responses were then discussed on the ACCRAC podcast.
Survey to 4th-year med students
A survey was created with Google forms and distributed via social media (Twitter) and the ASA Medical Student Component email list to fourth-year medical students planning to apply to anesthesiology residency programs in 2021. The survey asked anesthesiology applicants to share their concerns about the current application season and the changes that have been put in place due to the COVID-19 pandemic.
The first question listed potential areas of concern and asked participants to rank them from first through ninth. Topics of concern included: Interviews, lack of knowledge about a program, letters of recommendation (LORs), away rotations, lack of residency program at home institution, lack of interaction with residents, personal statement, MSPE, and exams. This list was compiled through various informal discussions with applicants in which they shared their most pressing concerns.
The second section of questions asked about specific concerns related to each individual topic listed in the first question. Each topic included a stem followed by multiple statements that participants had the option to select. The participant was able to select ≥1 answer choice or “none.” For example, respondents were asked about their concerns regarding LORs. Among some of their choices to select were, “I do not have an LOR from an anesthesiologist,” “My LOR is written by a doctor who has only observed my clinical skills/knowledge virtually,” and “Other...” allowing respondents to provide a free response.
In the third section of questions, applicants were asked how many programs they will apply to, how many interviews they will do, and how these plans have been affected by the pandemic and the move to virtual interviews.
Finally, free response questions were included to gain further understanding regarding the most significant concerns for applicants and to allow a space for thoughts to be expressed that were not asked about specifically in prior sections of the survey.
Respondents' #1 concerns
Survey responses were collected over the course of 10 days, and 159 applicants responded to the survey. Of the 159 applicants, 52.8% were U.S. MD students, 29.6% were U.S. DO students, and the remaining 17.6% were U.S. International Medical Graduate (IMG), non-US IMG, or previous applicants.
The topics applicants selected as their number-one concerns were interviews (31.4%), lack of knowledge about a program (15.7%), and exams (Shelf, Step 2CK, OET, etc.) (15.1%).
In addition, over 400 free response statements and questions were collected, summarized, and discussed on the ACCRAC Podcast.
Sharing the data with ASA community
Of the survey data collected from 159 anesthesiology residency applicants, the most prevalent concern centered around the implementation of virtual interviews. Over 80% of applicants feel as if the top percentile of applicants will receive the majority of interview invitations and attend the majority of those offered, leaving less opportunity for other applicants. Previously, this would not have been as much of a concern with in-person interviews due to the limitations of finances, travel time, and geographic location. However, with the implementation of virtual interviews, it is possible for applicants to interview at a west coast program until 4:59 p.m. PST and be present for an east coast program pre-interview “dinner” at 8 p.m. EST one minute later.
According to our data, 66% of applicants plan to increase their number of applications and none plan to decrease them. With shorter time for application evaluation by residency programs due to the delayed ERAS submission deadline, and decreased opportunities for meeting students through externships or home-anesthesiology rotations, applicants' concerns of not receiving adequate interviews seem justified and could lead to applicants not matching and programs not filling.
This survey was initially created to serve as a method of synthesizing anesthesiology applicant concerns related to changes in the residency application cycle due to COVID-19. Thus, this survey did not include extensive demographic data collection and analysis of how demographics might be contributing to applicant concerns. The initial intent was to share these results with an anonymous group of program directors and gain suggestions on approaches to these concerns, which could then be shared via the ACCRAC podcast. However, given the substantial response from applicants, it seemed important to share these concerns with the ASA community.
The COVID-19 pandemic has had a substantial impact on the residency application process for aspiring anesthesiologists, particularly as it pertains to virtual interviews, the review of applications, and the inability of applicants to gain in-person knowledge about prospective residency programs.
In addition to the responses from program directors on the ACCRAC podcast, ASA has attempted to address many of these concerns. In August, the ASA hosted its first-ever medical student ASA Town Hall, addressing the impacts of COVID-19 on medical students. The ASA Medical Student Component webpage also hosts numerous interview videos with program directors and a link to a sheet with available virtual open houses. Altogether, there are over 100 opportunities for applicants to engage with and learn more about residency programs. Additionally, the ASA annual meeting, free to medical student members, included a residency program meet and greet on an innovative virtual platform complete with breakout rooms and timed encounters with program representatives.
