Pre-pandemic, 3,000 fourth-year medical students flew back and forth across frozen Canada every January for interviews to secure residency positions and train as family doctors, psychiatrists, surgeons or other specialists.
And now for the second year in a row, students are embarking on these high-stake interviews by Zoom. Not so bad, they say – but at least give us back our visiting electives.
Prior to residency, medical students spend three or four years in medical school to become doctors. The second half of the program, called “clerkship,” is typically filled with clinical experiences in hospitals and community and rural settings where students interact with, and begin to care for, patients. These experiences, generally two or four weeks in duration, are called “visiting electives” and allow students to explore specialties and other cities.
COVID-19 grounded both processes: Students no longer leave their home university for visiting electives and all interviews for residency programs (done through a national Canadian Resident Matching Service (CaRMS) process) are virtual.
“It’s been a very different experience for our class,” says Danielle Judd, vice president of communications for the Canadian Federation of Medical Students. She started medical school during the pandemic and is now a second-year medical student at the University of Manitoba.
“There are people in my class that I’ve never had a session with in person … After this year, there will be a number of physicians that either have had their entire pre-clerkship curriculum, their entire clerkship or their entire residency in a pandemic.”
‘Most students are concerned about how it’s going to impact their match and their future career.’
With no visiting electives, students aren’t able to do the networking that usually occurs – making an impression in person or gaining references from those programs for the CaRMS residency application process. You can no longer get a feel for the curriculum and culture in different programs, Judd says.
“Most students are concerned about that and how it’s going to impact their match and their future career,” she says. “There’s nothing quite like that first-hand experience.”
To get a feel for various programs, Aman, a fourth-year medical student in Ontario, researched residency programs online and spoke with people already in residency.
He also accessed CANPREPP – a new online resource in which students experience and connect with any residency program across Canada.
But “it is more difficult to connect with a program and envision yourself working there for the next two to five years if you have never had an opportunity to visit,” says Aman.
For his CaRMS interviews, “there are certainly advantages and disadvantages to virtual interviews,” he says. “It is more difficult for my personality to come through in a virtual format … and to build a connection with the interviewer.
“However, a virtual interview allows me to be in a space (home) that I am more comfortable in and feels less intimidating. It also allows for less time, energy and money spent on traveling to and from different cities across Canada.”
Aman has been practising virtually with friends and medical residents for his CaRMS interviews, which began nationally on Feb. 28 and continue until March 20.
For a large family medicine residency program, the switch to a virtual process has been highly successful, says Stuart Murdoch, family medicine program director at the University of Toronto.
Last year, there were concerns about doing 800 interviews virtually, he says. Would the Zoom technology work? Would internet connections hold up?
“We practised, probably four times with a big group (of our staff), and it went really well,” says Murdoch.
In fact, “because we could do it virtually, we could interview more people in a session. Before, we had a rate-limiting step of how many offices we could use. We had 23 offices so we could only interview 23 people at a time … now we are up to 68 virtual offices.”
Virtual interviews also mean the need for all 800 applicants plus hundreds of interviewers to travel to downtown Toronto on evenings and weekends has been eliminated.
“No driving; no safety issue,” says Murdoch. “(Recently), we had our international medical graduate interviews, and we had that big snowstorm. I couldn’t imagine what it would have been like if everyone was trying to get downtown that day.”
Murdoch says he believes virtual interviews are also making the process more equitable for medical students. “It’s very expensive to travel the country and interview between the cost of flights and hotels, not to mention the stress. And suddenly the applicants can interview at any program they apply to that invites them for an interview … from home.”
‘I would say now, if given a choice, we would favour (keeping) virtual interviews.’
Pre-pandemic in 2020, Canadian medical students spent, on average, $4,072 applying and interviewing for residency positions.
The move to virtual interviews is also saving his residency program $30,000 to $40,000 per year in staff overtime, parking and catering costs. The program is instead using this funding to pay for Indigenous cultural safety training for all first-year family medicine residents.
“I would say now, if given a choice, we would favour (keeping) virtual interviews,” Murdoch says.
McMaster University residency programs were also happy with the virtual interview process, says Parveen Wasi, associate dean of postgraduate medical education.
“Programs were able to make appropriate choices based on the information they had, including the interview. Even with the lack of electives … overall they didn’t feel like they’d lost their ability to choose.”
Institutions do miss talking to people in person, though, and showcasing their programs, says Wasi. This is especially important for rural or northern program recruitment, where students benefit from getting a feel for the environment and the camaraderie level of those sites.
Another drawback is if the student’s home university doesn’t offer a program the student may be interested in, such as cardiac surgery or neurosurgery. In this case, students might not have any exposure to a specialty before making a career choice.
Will things switch back to in person after the pandemic?
The ban on visiting electives remains in place for the graduating classes of 2022 and 2023. Geneviève Moineau, president and CEO of the Association of Faculties of Medicine of Canada, says the organization is hopeful they may be back for the class of 2024.
For virtual interviews, “We have demonstrated now, at least for the one year, that we can undergo the CaRMS process virtually,” says Moineau. “And that there seems to be good satisfaction, both on the side of the students undergoing the interviews and the postgraduate programs who are the interviewers.
“At this point there has not been any determination to revert back.”