By Steven Clark
When the residency program director points to a chair and asks you to sit in it during your interview, it’s probably not a good idea to pick the chair up and move it next to her.
Or to look around the office and give your opinion about the posters on her wall. These are some of the residency interview “war stories” shared by Dr. Lizica Tronici, chair of the Department of Psychiatry at SBH and its residency program director.
“It’s a huge mistake to put that chair right under my nose,” she said. “And commenting about what they see on your walls is intrusive. Both show no understanding of personal boundaries.”
This reminder on what not to do in an in-person interview was a moot point in 2020 as the pandemic shelved all in-person visits for residency program candidates at hospitals throughout the United States. Instead, candidates for residency spots spent, in most cases, the past year learning about different programs and selling their worth remotely, in some cases never coming within thousands of miles of these hospitals. Residency program directors, meanwhile, scrambled to maintain the integrity of the process while following new rules.
The final verdict on the effectiveness of this year’s resident recruitment process will not be known for months – the time needed for residency program directors to compare their latest class to others, and for candidates to determine if the hospital is a good fit for them – yet at this stage there appear to be some pluses and minuses. While applicants could no longer personally view the next steps in their journeys to becoming physicians -buying your home for the next three to five years without stepping foot in it – they also did not have to incur the expense of thousands of dollars in travel and hotel costs. Some foreign medical graduates in the past have had no choice but to travel to the Bronx from such outposts as Egypt, India and Eastern Europe, costing them thousands of dollars.
“These interviews were much more convenient for us and the candidates [to get to know each other],” says Dr. Troneci. “But a personal interview gives me cues that this did not.”
She felt that maintaining certain practices within the psychiatry department – such as having candidates write essays during their remote visits, similar to what they did in the past during their in-person visits at the hospital – provided additional insight.
As a result of the remote process, the number of applications increased in most of SBH’s residency programs as many candidates, no longer burdened to travel to each interview they received, doubled the number of interviews they scheduled.
“We got about 100 more applicants this year, and they came from around the country, from the south, midwest, west coast, where before most of our applicants have been local or from certain states, like California,” says Dr. Scott Leuchten, residency program director in the SBH Department of Emergency Medicine. While he had more candidates to choose from for interviews, he questions whether the selection process, which is subjective during the best of times, might be even more open to question.
The pandemic, he says, prevented applicants chosen for interviews from spending the entire day at the hospital, where in the past they would meet residents, interview with faculty and tour the hospital and its ER. While he had test scores and recommendations to go on, he experienced much less of a personal connection.
“In some years as many as two-thirds of our residents had done rotations here as medical school students, so we knew them. This year, because of the pandemic, maybe only 20 percent of the applicants did. It’s hard to fool someone for an entire day, much less a monthlong rotation, but not so hard with a 20 – 30-minute visit,” says Dr. Leuchten.
Dr. Angelo Mascia, the department’s chief resident, who has spent six years in the hospital as a medical student and resident, agrees. “We got a lot more interest in the program from other parts of the country, which was facilitated by candidates not having to fly out for interviews. As an applicant, you could do three or four interviews in a day. Yes, it’s really nice to get students from all over the country. But, it’s also nice to see how they work with other residents and attendings. We missed that.”
Dr. Bert Petersen had some of his own scrambling to do in assuming the role of program residency director in the SBH Department of Surgery in September. This was several months after the untimely death of the previous director, Dr. Ronald Verrier, who passed away from COVID-19 several months earlier.
“We got a very diverse group of candidates this year, including many who started second careers and were formerly successful in fields like fashion and journalism,” he says. “We got applicants from medical schools around the country, and from HBCUs (historically black colleges or universities) that we never got before. I was very impressed with the candidates we interviewed.”
This year, residency programs at SBH provided candidates with printed materials sent digitally and encouraged them to visit their websites. A video was produced in-house that showcased the hospital and local places of interest (e.g. Arthur Avenue, Bronx Zoo, Botanical Gardens, Yankee Stadium). It included a segment narrated by Dr. Eric Appelbaum, chief medical officer, welcoming the applicants and letting them know that a couple of decades ago he had been in their shoes prior to becoming a resident at SBH. Additionally, in most cases, the video also included presentations by program directors and residents. On its website, the Department of Internal Medicine featured videos of its residents addressing topics ranging from academics to local housing. Other departments used social media platforms to reach out to applicants encouraging them to converse with their residents.
“I used Instagram because that’s the most popular social media handle for the age group of residents matriculating with the program,” says Dr. Paul Chu, director of the SBH pediatric dental residency program, who posted a virtual tour of the campus and neighborhood, intros from attendings, and a video of staff at work. “It was also very easy for me to use.”
Some residency program directors felt that by not seeing the hospital in person or having the chance to personally, say, eat lunch on Arthur Avenue, some things may have been lost. How much more residents would normally see, however, is debatable.
“I took an Uber from the airport to the hospital for my interview,” remembers Dr. Annie Contreras, chief resident in pediatrics who is from Venezuela and was living in Houston at the time studying for her STEP exams. “And then after the interview, I took an Uber back to the airport. I didn’t see anything of the Bronx.”
Their primary job, say residency program directors at SBH, was to keep the recruitment visit as close as possible to what it had been in the past, which typically included an orientation, a presentation from the chief resident, the chance to speak with other residents, and interviews with faculty (and individual department requirements, such as the essay by psychiatry). According to Dr. Janine Adjo, chair, Department of Pediatrics, “We prepared diligently for this, meeting every couple of weeks to go over every contingency. We looked at what platforms we would use and what the entire process would look like.”
She says that her team spent a great deal of time on ensuring the viability of their Internet connections. “I’ve had remote meetings with billion dollar companies where the video and audio connections went down. We didn’t want that. We looked to see if one room had better wi-fi than another, and tested the connections off campus. We had interviews with applicants from every continent except Antarctica, and while we could always reschedule, we wanted to avoid this if at all possible.”
She believes the remote interviews gave her sufficient insight into her pediatric candidates. It became readily apparent, for example, that one applicant read her answers. “People seemed more comfortable being in a setting they chose,” she says. Conversely, she believes, they should be held accountable for a disorganized or messy background.
Dr. Victoria Bengualid, residency program director in internal medicine, concurs. She says that several candidates disqualified themselves by talking too much in the virtual conference rooms that were set up as holding pens for candidates prior to one-on-one interviews with faculty. One applicant, apparently forgetting that the program’s secretary remained on the platform to deal with any technical problems, was overheard saying. “This is not my first choice. But I’ll come here if I don’t get in anywhere else.”
Although some programs had minor bumps in terms of technology, none “We had interviews with applicants from every continent except Antarctica, and while we could always reschedule, we wanted to avoid this if at all possible.” reported serious outages. “We didn’t change a thing,” adds Dr. Troneci. “We used virtual Microsoft TEAMS and it worked beautifully. From a workflow perspective it was much more efficient and time saving.”
At Dr. Bengualid’s suggestion, several residency programs used a platform called Third Friday, which internal medicine had used in past years to schedule and organize its candidate interviews. This year, Third Friday helped the department hold interviews for the 200 finalists they selected for interviews from the more than 4,000 foreign medical school graduates applying for coveted positions at SBH. Replicating the half-day in-person visitation days from past years, all applicants to the program entered the virtual conference room where they were greeted by staff, viewed a Power Point from the program’s chief residents, and spoke to residents before being pulled out for their one-on-one interviews with faculty.
“It was a really seamless process. I had a list of who I was going to speak to, I pressed the link, the applicant in the waiting room saw that and answered, and was pulled out of the room to meet with me,” says Dr. Bengualid. “I would do the interview and when I finished I pressed the button and sent them back to the virtual conference room. It was a very smooth process.”
Third Friday also provided onsite IT support, which allowed the departments to weather any problems, whether it was an Internet blockage in Egypt or a rainstorm in India that made connections difficult (and to manage time differences, which is a difference of 10 ½ hours in India).
The platform also provided applicants with a chance to tilt the odds in their favor by submitting 60-second “elevator pitches,” videos where they could discuss their hobbies or skills and further plead their case. Every bit can help as international medical school graduates (IMGs) face long odds, with only about 60 percent scoring American residency positions compared to about 94 percent of U.S. medical school graduates. Internal medicine’s entire 30+ person PGY1 class at SBH is 100 percent comprised of IMGs, as are far smaller classes in psychiatry and pediatrics.
This resulted in some very sophisticated videos – one shows a candidate in various baking sequences and another has the applicant looking like a TV anchorman or politician, turning to multiple cameras to make eye contact while delivering his presentation.
Some of the residency programs relied on creative solutions to sell their goods. Pharmacy, which had two PGY-1 and two PGY-2 (in critical care and infectious diseases) slots to fill, created an SBH virtual booth for candidates to view hospital and department videos,nfind printed materials and participate in a chat room.
Although the department was unable this season to attend various pharmacy showcases that provided them in the past with access to hundreds of pharmacy school graduates, the customized booth they created from a template provided by the American Society of Health-System Pharmacists, in addition to the Third Friday platform, more than met their expectations.
“It was a huge success,” says Amanda Rampersaud, the department’s residency program director. “The process went very well. We were limited in the number of people we could reach in our virtual booth at one time – unlike at the showcases where we would normally meet hundreds – but I think it went very smoothly. At the beginning, I thought it would be a complete nightmare, but it was far from that.”
Programs like pediatrics, surgery, pharmacy, emergency medicine and various dental programs have a March match day, whereby an algorithm merges the institution’s ranking with those of the applicant to foster a match. This creates additional uncertainties for program directors and candidates – are applicant and institution on the same page? – whereas programs like internal medicine and psychiatry can make offers to candidates at any stage of the recruitment process.
Match Day validated most of the hopes of the hospital’s program residency directors. “We matched high and are very happy with our incoming general surgery residency class,” says Dr. Petersen. Dr. Leuchten also feels he had a successful match – with new residents representing 11 different medical schools (12 osteopathic and three allopathic schools in what until recently was a 100 percent osteopathic residency program). However, unlike in the past, only five incoming residents had previously done rotations with the hospital as medical students while 10 “have never stepped foot on campus.” Dr. Adjo filled her six first-year slots with candidates that were “green lighted” by all the department’s interviewers. Pharmacy matched with its top two PGY1 candidates and its top PGY2 infectious disease candidate. While the department did not match for its second-year critical care program and will enter the post-match stage, this is a process it is not unfamiliar with.
Dr. June Harewood, program director with the orthodontics residency program, says she did not get quite the same feel for candidates as she had in past years. “We didn’t get to spend as much time with them. Whether we judged them correctly is hard to say.”
Overall, residency program directors and applicants gave positive feedback on the interviews. “If we interviewed applicants in person there might be something we pick up that we wouldn’t in doing it virtually,” says Dr. Troneci. “We didn’t have the experience like in the past where a resident or attending might pick up something in the time they spent with the candidates. In the past, they might come back and say, ‘He didn’t seem that interested,’ or ‘She didn’t want to go inside the unit.’ Unless someone was totally inappropriate or unprofessional on the screen, you wouldn’t pick that up.”
Dr. Bengualid says that, “While you can tell whether a person speaks English well enough or makes good eye contact in a remote interview, you may not see relatability as well. It doesn’t quite feel the same.”
Yet, they and other residency program directors believe there are certain elements of the virtual process they would like to consider continuing once life returns to normal. For example, they would consider waiving the requirement for candidates to interview in-person at the hospital.
Dr. Adjo found the remote process to work extremely efficiently. “We were able to give a comprehensive review of the program and had the same experience to see if someone was a good fit. There was a far lower (interview) cancellation rate and the department saved money on lunches and printed materials.”
“It’s very difficult for some applicants to have to come here and then fly to all these places and the process is costly,” says Dr. Bengualid. “I would prefer to do this system and give them the option to then come visit if we accept them. I would say the question to me, which we won’t know for some time, is whether we selected the best candidates possible.”
Adds Dr. Troneci, “I would like to see if there is something we missed in the interviews. But as of now I think if you’re coming from out of state, we would be happy to do it virtually.”
Regardless of whether resident recruitment visits take place in-person or remotely, there will still be interesting war stories to tell. Perhaps to remind herself, Dr. Troneci keeps a box in her office from an applicant that contains one very large sneaker with red laces and a handwritten note that reads: “I want to have the privilege of introducing myself to you and potentially having the opportunity to work with your great residency program. The reason why I have a shoe in the box is to represent that I have gotten one foot in the door. Please meet with me so I can get the second foot in the door as well.”
“His scores were very low, so I guess he figured he had nothing to lose,” says Dr. Troneci.
After some deliberation, following input from faculty and residents, the department chose not to interview him or allow him to get his second shoe in the door.