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The coronavirus disease 2019 (COVID-19) pandemic has altered the training and preparation of future otolaryngologists. United States otolaryngology residency applicants are preparing for an unprecedented application cycle with fewer opportunities for clinical exposure and the prospect of virtual interview days. These changes may affect residency interviews and the otolaryngology match long after the pandemic subsides and negatively affect the process for applicants and programs. The effective elimination of away rotations by COVID-19 strips applicants of an opportunity to express interest in a program while virtual interview days may allow strong applicants to attend many more interviews than required to match, wasting interview positions that might be better served by other interested applicants. This commentary discusses how a national interview calendar and initial interview invitation date may add some reassurance for applicants and residency programs for the upcoming otolaryngology residency application cycle.
The COVID-19 pandemic has forced academic otolaryngology programs to rapidly adapt to the uncertainties of this crisis. When students were blocked from in-person clerkships, programs found innovative ways to teach outside of the operating room, clinic, and hospital wards. The programs began virtual grand rounds, increased social media presence, and offered virtual information sessions. Many aspects of the typical otolaryngology residency application process have been changed by the pandemic. To maintain a safe but fair process for all applicants, a coalition of groups with a stake in medical student education, including the Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, American Medical Association, and National Board of Medical Examiners, discouraged away rotations for applicants without a home program in their desired specialty and called for the use of virtual residency interviews in lieu of in-person interviews.1
Applicants may appreciate the financial and logistical benefits of virtual interviews, but the residency program directors are rightfully concerned that less-expensive, logistically simpler virtual interviews will encourage well-qualified applicants to accept more interviews in an attempt to increase their odds of a successful match while occupying interview positions that might be better served by other applicants. This issue predates the current pandemic but may be exacerbated by virtual interviewing. In previous interview cycles, 26% of the applicants received half of all interview offers.2 Although some authors have called for a cap on the number of interviews a student can accept,3,4 a better alternative exists in the form of a nationwide otolaryngology interview calendar and initial invitation date.
Implementing a National Interview Calendar
Under a national interview calendar, residency programs would schedule interviews on 12 predetermined dates across the US. A 12-date calendar was chosen based on data from earlier years suggesting that 12 contiguous ranks were associated with an approximately 90% probability of an applicant’s successful match with the assumption that applicants rank all programs where they interview. As in past years, additional interview dates would have a marginal association with an applicant’s odds of matching.5 This calendar would be publicly available to both programs and applicants. Programs would select their interview dates from the 12 available while viewing the scheduled dates of their fellow programs and confirming their dates shortly before the start of the interview-invitation week.
Limiting interviews to 12 dates puts a cap on the number of interviews an applicant may accept while allowing programs to tacitly coordinate dates. Geographically close programs or programs with a research track may choose nonconflicting dates to allow specific applicant pools to interview at multiple programs. Conversely, programs may choose dates that conflict with another to encourage applicant choice. This action provides applicants the opportunity to signal their preference for a program when they accept an interview. An applicant who might attend 20 interviews in previous cycles must choose which interview to attend when they receive multiple invitations for the same date. This narrowed selection provides the program that ultimately interviews the applicant the knowledge that the applicant chose to interview at that program despite possibly receiving offers for the same date.
Implementing a National Interview Invitation Date
Another key aspect of a national otolaryngology interview calendar would be an initial interview invitation date. All participating programs would commit to sending their first round of interview invitations on a specified date in the fall. Over the next few days, applicants would evaluate their various invitations simultaneously and decide how to fill the 12 available interview dates on their calendar. On a specified date 2 to 3 days after the initial round of invitations, the applicants would notify programs simultaneously whether they accept or decline an invitation. After the initial interview offer window concludes, programs would fill any remaining interview positions as they choose. Because most of the interview calendar for applicants and programs is established early in the season, the problems typically posed by cascading interview cancellations from applicants is minimized, although not completely resolved. Similar measures were implemented for integrated plastic surgery programs in the 2019-2020 cycle, although we are unaware of any studies analyzing these changes. The Otolaryngology Program Directors Organization (OPDO) has tried to address the problem of cascading interview cancellations by encouraging programs to extend invitations between November 9 and November 30; however, because applicants are incentivized to accept the interview invitation within hours or minutes of receipt, interviews are accepted on a rolling basis without allowing applicants to compare offers simultaneously and decide how to handle conflicting offer dates.6
The benefit of a national otolaryngology interview calendar and initial invitation date stem from their utility in signaling a preference during the interview selection process. In previous years, applicants have used the away subinternship to signal their preference for a particular program. The OPDO has responded to the cancellation of away rotations by implementing a 5-token preference signaling system that allows for signaling when applications are initially submitted.7 Given the small number of tokens relative to the historical number of interview positions, the strongest applicants will continue to receive interview invitations from unsignaled programs. The problems created by these applicants overinterviewing persist. Adding an objective preference signal as applicants select interviews benefits both applicants and programs. Applicants effectively communicate their willingness to rank a program above others that made interview offers for the same date, and programs have greater certainty that the applicants they interview will rank the program favorably. This calendar prevents qualified applicants with 12 interviews from accepting additional interviews at a program they have little interest in ranking favorably, for marginal improvement in their odds of matching. These changes may result in programs filling their available spots with fewer contiguous ranks.
Although this system aids applicants in planning interviews, limits the number of interviews they may attend, and creates a method for preference signaling as applicants accept interviews, it does not aid programs in selecting whom to interview. However, this is adequately addressed by the OPDO’s new signaling program.7
In these uncertain times a national otolaryngology residency interview calendar and invitation date offers programs and applicants more certainty by allowing applicants additional ways to express their preference for a program and prevents the problems created by the well-qualified applicant who overaccepts interviews. The benefits of this system may persist beyond the current pandemic.
Corresponding Author: Christopher D. Badger, MD, MBA, Division of Otolaryngology–Head & Neck Surgery, George Washington University School of Medicine, 2300 M St, 4th Floor, Washington, DC 20037 (email@example.com).
Published Online: December 30, 2020. doi:10.1001/jamaoto.2020.4999
Conflict of Interest Disclosures: None reported.
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Badger CD, Thakkar P, Zapanta PE. Implementing a National Otolaryngology Residency Interview Calendar—Planning for Uncertainty During the COVID-19 Pandemic. JAMA Otolaryngol Head Neck Surg. Published online December 30, 2020. doi:10.1001/jamaoto.2020.4999
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