Article In Brief
Neurology programs directors are relying on virtual and digital tools as well as social media activity to recruit and interview neurology residents and fellows during the COVID-19. Some of these changes may become part of the regular way of doing business.
With interview plans upended by the COVID-19 pandemic, Daniyal Asad, MD, found himself in the same quandary that many medical students and resident physicians face: choosing a training program without an on-site visit.
While he was the chief resident in neurology at the University of Connecticut School of Medicine and Hartford Hospital, Dr. Asad traveled to two vascular neurology fellowship programs in January. Then he got word that his upcoming in-person interviews at 11 other institutions would be converted to virtual formats.
“Initially, I was a little bit apprehensive,” Dr. Asad said, concerned that virtual interactions could undermine his chances. “I wondered, How does one differentiate oneself from all the amazing applicants, especially when you’re not meeting them in person?”
But the unexpected shift in interview dynamics did not diminish his resolve. For only a minute into the initial interviews, it felt strange conversing through a computer screen. He acclimated quickly.
“The only downside” stemmed from being unable to walk the halls of a hospital to “get a general feel for the environment.”
In mid-May, with the stroke fellowship interviews behind him, Dr. Asad matched with his top choice: Massachusetts General Hospital. “It ended up working out fine,” he said, even without a trip to Boston.
“All programs went above and beyond to make applicants feel comfortable and provide information,” Dr. Asad said. “It ended up working out fine, even without a trip to Boston.
Indeed, in the last few months, neurology residency and fellowship directors have been brainstorming how to best showcase their training programs virtually and engage with applicants on digital platforms as the COVID-19 pandemic continues into the foreseeable future.
From revamping their academic medical centers’ websites to boosting their departments’ existence on a variety of social media—from Twitter to Facebook, Instagram, and Doximity—programs are also highlighting the experiences of current resident physicians and fellowship trainees.
Society media actually played a big role in the recruitment process for one neurology resident, even before the pandemic hit. Aaron Zelikovich, MD, first-year resident in neurology at Weill Cornell Medicine in New York, said he first met Joseph E. Safdieh, MD, FAAN, editor-in-chief of Neurology Today at the AAN Annual Meeting in Los Angeles in 2018. “It was during the round-robin for medical students. I started following him on Twitter, and I learned about Weill Cornell’s neurology department through all the different Twitter promotions that they were doing throughout the year. It gave me a lens into the residency program even before I thought about applying.”
Dr. Zelikovich is one of the neurology residents working to marshal resources through social media to help other medical students and residents share information and tips on the programs throughout the US.
Some leaders are hosting virtual information sessions prior to recruiting season and opening up Grand Rounds to a broader audience, including prospective trainees. Meanwhile, they are featuring virtual video tours of health care facilities and the surrounding communities where trainees would live and relax after work.
Social Media Presence
“Programs and departments have been ramping up their social media presence,” said Leticia Tornes, MD, FAAN, clinical associate professor and neurology residency program director at the University of Miami Miller School of Medicine. “For example, I’ve seen many more program directors joining Twitter.”
In some cases, residents are posting snippets of an entire workday “to mimic in-person tours,” Dr. Tornes said.
The AAN released a detailed list of suggestions for interviewees for medical students and residents facing virtual interviews, she pointed out.
“Review the virtual interview tips provided by the AAN. Be prepared, test your equipment, practice where to look at the computer, and be yourself,” said Dr. Tornes, who participated in the AAN workgroup’s calls to craft the guidelines. She also emphasized the importance of becoming familiar with a program’s specifics before the virtual interview.
Reach out to Program Directors
“Program directors recognize that we are all in this together,” she said. “It’s new for everyone, and we will get through it. There will be hiccups, and that’s okay.”
“Program directors, residents, fellows, and faculty are increasingly accessible via e-mail and social media to answer applicants’ questions,” said Anita Shelgikar, MD, clinical associate professor of neurology and director of the sleep medicine fellowship at Michigan Medicine, the academic medical center of the University of Michigan.
“Many programs are creating more engagement opportunities, such as virtual social hours with current residents and fellows, so that applicants are able to get a better sense of the training program,” Dr. Shelgikar said.
Her advice to “all the applicants seeking guidance in this new virtual interview landscape: Don’t hesitate to reach out to a program director or program coordinator if you have questions about a program. We are here to help and want to see all applicants—the future clinicians, researchers, and educators in our field—thrive during their training and throughout their careers.”
To facilitate the transition of trainees during a pandemic, a work group of the Coalition for Physician Accountability, of which the Accreditation Council for Graduate Medical Education is a member, recommended that institutions permit only online interviews and virtual visits. It also advised against setting up away rotations except in unusual situations to advocate for public and professional safety.
Leveling the Playing Field
These recommendations will be in effect regardless of a candidate’s proximity to a particular institution. “That provides a level playing field for all of the applicants,” said Charles C. Flippen II, MD, FAAN, professor of neurology, vice chair of education, and director of the residency training program at the David Geffen School of Medicine at the University of California, Los Angeles.
“As elective rotations remain suspended during the pandemic, some students may miss out on an ‘audition’ to demonstrate their work ethic and personalities. There may be a little amplification of being on the home team,” Dr. Flippen conceded, with an institution’s own medical students maintaining a slight advantage in consideration for its training program. However, he said, the lack of this opportunity won’t have much impact on the overall matching process.
MaryAnn Mays, MD, director of the neurology residency program at Cleveland Clinic, said she expects medical students to pursue interviews at more programs during this virtual recruitment season than in prior years, when an on-site visit that incurred travel expenses was the norm for securing a match. As a result, the program she oversees plans to interview about 130 applicants virtually for 10 neurology residency positions, compared with the 100 candidates that it typically considered in nonvirtual years. However, she doesn’t believe it’s necessary for students to do more than the typical 10 to 13 interviews. One reason her program is adding interview slots stems from an increasing number of matches this year.
“On both ends of the spectrum, it’s interesting. Students are more nervous,” said Dr. Mays, a migraine specialist at the Headache and Facial Pain Clinic within the Neurological Institute at Cleveland Clinic. “From a program director’s perspective, they don’t realize there’s a lot of unease on our end, too, to get the right applicants.”
Setting up a MedTwitter Account
Erica A. Schuyler, MD, FAAN, neurology residency program director at the University of Connecticut, agreed that the elimination of travel costs may significantly increase the number of applicants. “Despite the additional interviews, reviews, and rankings of candidates, virtual recruitment really is our best option for safety and equity, and we will all make the best of it,” she said.
With that in mind, Dr. Schuyler helped form and now chairs a virtual recruitment workgroup committee, comprised of members of the Graduate Education Subcommittee, the Undergraduate Education Subcommittee, and the newly formed AAN Consortium of Neurology Education Coordinators. She is also chair of the AAN Consortium of Neurology Program Directors.
To raise her own program’s visibility, she created a MedTwitter account in early August. The program already had a presence on Facebook, where her coordinator offers updates on wellness initiatives and features neurology residents participating in leisure activities, Dr. Schuyler said. On its Instagram account, the program has been holding virtual information sessions geared toward applicants, she added.
Designing ways to give applicants a realistic representation of a program without an in-person visit is a two-month long endeavor, said Marc DiSabella, DO, program director of the child neurology fellowship at Children’s National Hospital and George Washington University School of Medicine & Health Sciences.
Dr. DiSabella envisions showcasing virtual panels of experts in each subspecialty group. Each group would deliver a brief overview of the program and then engage in a question-and-answer session with prospective applicants. As director of the headache program and medical director of neurology education, he also plans to host virtual conferences that discuss difficult cases, inviting prospective applicants to attend and learn from the presenters.
Even when the pandemic is over, “I don’t think we’ll ever go back to a nonvirtual system,” he said.
Videos fill in some of the visual gaps during virtual recruitment. Any hospital tour ideally would include the resident call room and computer-based work areas, said Pearce J. Korb, MD, MPHE, FAAN, associate professor of neurology and director of medical student education at the University of Colorado Anschutz Medical Campus.
Hosting Happy Hours
Many programs intend to include virtual “happy hours” with current trainees as part of the matching process. Still, “losing the spirit of the interview” concerns Diego R. Torres-Russotto, MD, FAAN, professor of neurological sciences and chief of the movement disorders section at University of Nebraska Medical Center in Omaha.
An important aspect of the process entails going out to dinner with faculty and fellows and observing the interaction with the candidates to “see if it clicks, if it’s a good fit,” said Dr. Torres-Russotto, who is also director of clinical neurology students’ education.
“The mentoring that happens after a fellowship lasts a lifetime. They will continue to be our mentees forever, so it is a very important choice, both for them and for us,” he added. “How can you foster that kind of interaction in an online” interview?”
Setting Up for the Virtual Interview
Before the virtual interviews, Ahmet Hoke, MD, PhD, FRCPC, professor of neurology and neuroscience and director of the neuromuscular division at Johns Hopkins School of Medicine, is taking a more active role in communicating with applicants.
Dr. Hoke will schedule a one-on-one conversation with each candidate. He intends to provide some background about the neuromuscular fellowship program and elaborate on “the depth and breadth of the faculty expertise.”
In addition, the program is utilizing several resources from the Johns Hopkins University’s Graduate Medical Education office, including videos about the school, hospital, and Baltimore.
Preparation is key for applicants to maximize their chances for successful interviews via Zoom, said Dr. Hoke. He recommends maintaining a robust internet connection to ensure that sound and video operate as seamlessly “as if the person is sitting across from you in the office.”
The background matters, too, Dr. Hoke said. A plain wall, perhaps with pictures on display, would be ideal. “If the applicant has something on the wall related to their outside interest, that would be great as it could spark a conversation,” he said. Whatever is visible—for instance, in an office with bookshelves—has to appear tidy, not cluttered.
Emily Poole Pharr, MD, MS, neurology residency program director at Wake Forest Baptist Health in Winston-Salem, NC, said preparation is “even more important when the interview is virtual.” Both the interviewer and the applicant should have already formulated questions, she said.
The interviewer should put the candidate at ease with an introduction and outline of the format, while allocating time for the candidate to ask questions, said Dr. Pharr, who is director of the Comprehensive Multiple Sclerosis Center.
“Minimizing distractions such as emails and cell phones is also crucial for a successful virtual interview experience,” she said.
Overall, Dr. Pharr noted, “This virtual interview season has provided a great opportunity for program directors around the country to take a look at how we connect with applicants.”
How to Make the Virtual Interview Work
Sushma Kola, MD, chief resident at Mayo Clinic in Rochester, MN, recently completed the virtual recruitment process for a movement disorders fellowship program and shared with Neurology Today her impressions of recruitment through the virtual process.
From an applicant’s perspective, how does one assess programs and determine the right fit when you can’t travel to see them in action?
It’s challenging! A lot of program directors shared an introductory presentation that helped me get a feel for their program structure, strengths, and values. I also loved having the opportunity to informally chat with current trainees during virtual happy hours or dinners, because I could experience their camaraderie, culture, and interests outside of work.
How did you prepare for the interview process on Zoom?
My initial preparation was similar to what I did to prepare for in-person residency interviews. I made sure I was well-versed regarding what was on my CV and in my personal statement, did some soul searching so I knew what I was looking for in a program, reviewed program websites, and prepared answers to typical interview questions. But because all of my interviews were on Zoom, I had to focus how I would portray myself on screen. I took time to create a nice interview space and background with good lighting and no distractions. I also made sure to have a comfortable chair, water bottle, and snacks nearby!
How was this different than what you had expected in the usual protocol of traveling for in-person residency interviews?
Aside from the obvious, I found that my fellowship interview structures were quite diverse. My interview days ranged anywhere from 30 minutes to over nine hours long. I also had a mix of one-on-one interviews and those where I spoke with multiple faculty at once. At a few programs, I was asked to present a video case of an interesting patient.
How did you get a feel for the place without physically visiting?
Even though it was difficult not physically being at an institution, I could still get a good sense of the program atmosphere through talking with faculty, support staff, and trainees. I benefitted from programs that had virtual tours (live or pre-recorded) and structured times to meet with current fellows (through virtual happy hours and dinners).
Is not having to travel for interviews a plus from the standpoint of eliminating the expenses associated with that, in addition to the financial burdens of medical school?
My significant other recently paid over $6,000 to attend a similar number of fellowship interviews before the pandemic. It was nice not having the financial burden, though at the expense of not being able to experiences programs and cities in person. I did appreciate not having to miss multiple days of work for each interview as travel time was not an issue.
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