Nothing likely to 'Match' this residency process in one strange year

Matching into a residency program is supposed to be one of the pinnacle experiences during a medical student’s education.

But in the COVID-19 pandemic year, the experience for everyone involved was beyond typical.

The pandemic caused disorder and uncertainty in the traditional Match season as thousands of residency applicants in the United States and internationally, as well as numerous residency programs at hospitals and institutions, scrambled to create alternative and fair processes that would work within an environment of COVID-19 restrictions.  

At MUSC, residency programs had already been anticipating a change since Spring 2020 as the university ceased in-person classes and moved all students to virtual learning. For medical students, clinical clerkships and away rotations were disrupted as recommended by the American Association of Medical Colleges (AAMC).

According to MUSC Graduate Medical Education (GME) institutional coordinator Ann Ronayne, who helps to manage 80-plus specialty and subspecialty residency programs in 24 areas at MUSC, many of the campuswide residency programs managed much of their planning and changes on their own. “Medical residencies and fellowships are so different. There’s not a one-size-fits-all approach to managing things. Most of the planning was left up to the residency program directors and coordinators to figure out as to what was best for their programs and their needs,” said Ronayne.

Department of Neurology residency program coordinator Cassaundra Tucker was appreciative of the support and resources provided by the GME Office. “The GME office stepped out of its scope to keep us informed about the latest guidelines and standards outlined by the Accreditation Council for Graduate Medical Education (ACGME) that needed to be communicated and made sure that these lines of communications remained open,” said Tucker.

The ACGME is the organization responsible for all graduate medical training programs for physicians in the United States.

Pediatrics residency program director David Mills, M.D. and coordinator Becky Hasegawa agree. “The GME office was very helpful with hosting intermittent virtual discussions among program directors and coordinators as we shared ideas, discussed methods to plan virtual conferences and safe gatherings, discussed residents’ wellness and strategy, etc. It was really helpful to hear this as it didn’t just affect our program, as these guidelines affected everyone. We were truly in this together to share ideas,” said Mills.

For the Pediatrics residency team, both Mills and Hasegawa quickly realized that the traditional recruitment process would change in the pandemic year sometime in mid-to-late summer; and they began to plan accordingly. “Since applicants would not be able to experience their residency programs’ ‘family vibe,’ collegial culture, the beautiful new MUSC Shawn Jenkins Children’s Hospital and MUSC Children’s Health R. Keith Summey Medical Pavilion and the City of Charleston, we began thinking of ways to engage applicants in various creative ways,” Mills said.

Taking that concept a step further, the Pediatrics residency team also included current residents and medical students from MUSC who were interested in pursuing a pediatric residency - and established virtual recruitment committees to serve as resources in planning and feedback throughout the process.

These changes also led to important redesigns of the pediatric residency website and social media accounts (specifically Instagram @muscpeds) - adding videos and updating content and highlighting different aspects of the program’s curriculum.

Neurology did the same - utilizing the opportunity to enhance its electronic presence on the web. “We realized our webpage needed to represent our program and the Charleston area on a more current level. We pushed hard to update our presence on social media. We also created a recruiting video that received lots of positive feedback from applicants about its content and resources. We scrambled to improve virtual platforms like Zoom and Thalamus as well,” Tucker explained. Thalamus is a comprehensive interview scheduling platform used to connect residency applicants.

According to Tucker, the Neurology residency team asked themselves how they would make applicants comfortable enough so that elements of the residency recruitment process, such as virtual interviews, were not so one-dimensional and that the interviews would be taken seriously. “For MUSC Neurology’s Match process, we focused on a combination of things that I think made applicants get a sense of our program and what MUSC and Charleston offered as well,” she said. “We made sure our applicants knew our residents had support in all areas.”

When the National Residency Matching Program (NRMP) launched “Match season” on Sept. 1, 2020, student-candidates began preparing and uploading materials to the AAMC’s Electronic Residency Application Service. And by October, and for the next four months, residency programs began recruiting and selecting their candidates for interviews.

Dr. David Mills, right, rounds with pediatric physicians at MUSC Shawn Jenkins Children’s Hospital. Photo by Sarah Pack

The Pediatrics residency program launched the process with a virtual open house by which students from across the U.S. and abroad could visit their website, learn about the program and decide if they wanted to apply to the program. In a typical Match, the program hosts around 200 applicants for in-person visits and interviews. During the pandemic year, a total of over 1,000 people applied with 280 candidates virtually interviewed for 17 first-year (PGY-1) resident slots. According to Mills, the team determined which candidates would proceed to interviews, and then planners offered virtual happy hour events with current residents, which were meant to be casual question-and-answer sessions. For the virtual interview day, they built in more interaction with candidates through organized virtual coffee chats with current pediatric residents, using Zoom breakout rooms. Finally, Mills met with candidates in small groups in 20-minute sessions, where he discussed experiences and answered questions.

“We wanted enough ‘face time’ with the candidates to market our program and evaluate the applicants,” said Mills. “A huge part of what we do is learning about that applicant. We asked questions like, ‘Will that person be a good fit for our program?’”

Since it’s difficult to assess an individual fully on camera versus in person, Mills also evaluated each applicant’s interactions with him - gauging his or her intercommunication skills via webcam, nonverbal communications and responses to behavioral-based questions. “In the past, it may not have been a red flag to me, but in this virtual process, it became a big deal,” said Mills, “These were all features that were important to me in looking for a good resident.” He also placed more of an emphasis on letters of recommendation when determining each applicant’s score.

For March 19’s Match Day results, Pediatrics matched a total of 22 interns - 14 categorical pediatric interns, three Primary Care interns, one child neurology and four Internal Medicine/Pediatrics interns - two of whom are MUSC Class of 2021 soon-to-be graduates.

Neurology also followed a similar process on its virtual interview days. Tucker would meet with applicants to answer questions and resolve any technical issues. Nicholas Milano, M.D., residency program director, conducted a program overview with candidates, followed by a virtual lunch with Neurology residents, interviews and a farewell with Milano.

“Virtual interview were an atypical experience for both faculty and candidates. Due to the interviews being virtual, it made assessing the program and candidates more challenging," said Tucker. Therefore, candidates were provided with information about the program prior interviews. As well as email addresses of everyone who participated with the interview process. This allowed candidates to email specific questions, as some preferred to email specific questions to ask a question privately rather than in a virtual group setting. “Being responsive and providing alternative methods of contacting the program such as text, messenger in addition to great residents, faculty and a strong program, I believe are some of the components applicants noticed and appreciated.”

The Neurology residency program manages a total of 34 residents and fellows as well as four neuro-psychiatry residents and four child neurology residents. For this year’s Match process, the program interviewed 95 applicants and matched eight PGY-1 intern residents.

With the pandemic still evolving, many people involved in medical residency programs feel that this experience - or something like it - might still exist for the 2021-2022 Match process.

According to Mills, the Pediatrics residency program continues to evaluate its process. They shared brief surveys with all applicants to determine what went well and how they could improve the experience in the future. “I really envision that virtual opportunities will continue to play a big role in the residency recruitment process in the future. I do see some type of hybrid model using virtual and in-person interviews across the country moving forward.”

According to Ronayne in the GME Office, “I believe the AAMC wants to see how this year’s Match program goes and how successful matches will be. Website platforms, virtual tours and other tools will stay with us, and we can’t get complacent about the information that’s out there. Programs will need to continue updating their information to make them more competitive with other residency programs around the country."