Wednesday, August 21, 2019

More chaos in the medical resident interviewing process

Not only do graduating medical students go on (too) many interviews for residency positions, but the process by which interviews are offered and accepted is chaotic. (I'm reminded of the process of offering and accepting actual positions in the 1940's, before a matching clearinghouse was first developed...)

Here's a paper from the August 2019 issue of the Journal of Graduate Medical Education, by three concerned doctors at Northwestern University, who describe the situation and then offer their own suggestions. (I admire the description, and am skeptical that the suggestions are radical enough to change the incentives responsible for the current congestion...)

A Challenge to Disrupt the Disruptive Process of Residency Interview Invitations
Matthew R. Klein, MD, MPH
Sandra M. Sanguino, MD, MPH
David H. Salzman, MD, MEd

"Residency programs may also contribute to the sense of urgency to secure an interview by offering
more invitations than available interview slots. The rise in the number of applications per
applicant, while certainly multifactorial, is facilitated in part by the ease of online interview scheduling...
"In the current environment, applicants who receive an interview invitation while they are in a situation where interruption is impossible—such as taking a clerkship examination, assisting in an operating room, performing a bedside procedure, participating in a difficult conversation with a patient or family, rounding on the wards, or simply being asleep as a result of time zone differences—are effectively penalized. A delay in response may result in the inability to schedule a favorable date or an increase in the cost to travel to an interview at a less convenient time, or it may preclude an interview altogether if all interview slots have been taken.
"We propose a 2-step process that we believe balances the need for residency programs to recruit
applicants and schedule interviews with the goal of preserving an environment that allows students to
maintain their commitment to their educational and patient care responsibilities. We recommend the
following process
Step 1: A program informs an applicant of an invitation for an interview. In that communication,
the program shares the interview dates and indicates the date and time when online interview
scheduling will become available. This allows medical students to plan in advance when they
need to be briefly excused from clinical or educational responsibilities to attend to interview
Step 2: At the time indicated in the initial communication, and no earlier than the day after
that communication, the online interview scheduling system opens to applicants
"In an effort to further decrease pressure to reply immediately to an interview invitation, programs
should also ensure that the number of initial invitations does not exceed the number of interview
slots available. Additional interview offers from a wait-list could occur as needed based on unclaimed
interview slots or subsequent cancellations."

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