Years from now when we look back, will we measure time in terms of B.C. and A.C.—Before Covid and After Covid? It’s hard to imagine a time when we will we once again feel comfortable walking hospital halls without a mask. Between businesses converting to work-from-home models and all levels of education adapting to the virtual world, there’s a new normal. As someone with a healthy appreciation for technology, one that at times borders on obsession, I was excited by the prospect of another virtual residency interview season. This would be the second rendition. Kinks would be smoothed, and surely, I could show off my charm and wit via Zoom/Webex/Thalamus. Plus, I was grateful for the chance to save a couple thousand dollars.
But, when I sat and thought about what being virtual meant, ambivalence washed over me. We, as bright-eyed, bushy-tailed medical students, would be choosing our futures via computer screen, not that I had any misconceptions about the power of the in-person interview. Anyone can put on a show for a day and a half, albeit it is easier to do so on Zoom. My cohort of future physicians would be entering three-, five-, seven-year contracts with hospitals they may have never seen, in states they may have never visited.
The five to seven years we spend as vascular surgery residents, the hours we spend with the same people within the same four walls, are longer than some marriages. We were being asked to choose that partnership virtually, limited to computer screens, Google searches, video conferences, and Grubhub deliveries. There wouldn’t be a true resident dinner where we could ask the questions we were too scared to ask on the big day. We could try to ask on the Zoom socials, but there wasn’t that human connection. Usually, one or two applicants might be the ones steering the conversation, popping up on screen more often than others. Occasionally, residents would have questions for each of us, icebreakers. Other times, we would sit there in awkward silence as the residents joked amongst themselves. Hard to read the room when the room is pixelated.
In a time when masks and nasopharyngeal swabs weren’t barriers to in-person smiles and handshakes, I imagine I would pick a program by looking at how people interact. It worked for medical school. I chose based on tangibles such as research, community outreach, rank and rigor, but in a tie between two programs, I thought back on culture. During the tours, who smiled at friends, greeted faculty without pause, and who made room for the janitor and treated them with respect? I chose right. I have been encouraged to grow and been supported in strife.
Now, we’re being asked to do so behind a screen, without that extra touch. So, I looked at the way people communicated in the main session, how engaged they were in the conversations, who they acknowledged when I asked what they’re most proud of about their institution. For me, it was about the people.
I tried my best to see where I could challenge myself to grow as a person and as a leader, be surrounded by those that support my learning and my inevitable failures, and learn to be an outstanding vascular surgeon. It’s hard without being in the room.
There has been a lot of talk about how to bridge health disparities in the U.S. Overwhelmingly, we need more doctors that look, sound and think like our patients. Underrepresented students already have enough on their plates with student loans, implicit bias, racial inequality, gender discrimination. We hope to make medical education more accessible, yet we have been asking disadvantaged students to pay out-of-pocket to interview.
To even get the interview, there are biases and barriers. Passing standardized tests is anything but fair, between the cost to merely sit for the exam, the disadvantage for non-native English speakers, and the limitations on persons with disabilities. Having famous mentors and letter writers is a luxury of your institution. Performing well on rotation is at the mercy of your circumstances. Life happens.
Away rotations
Moreover, beyond the cost of interviews, there’s the “aways.” In a typical year, students do up to five away rotations. Financially, this means covering rent at home, and subletting on the road, paying for food, transportation, and utilities along the way.
This practice favors the fiscally fortunate, and pushes others less so into more debt. That certainly is not helping to bridge disparities in the field. At times, it seems medicine, for all its advances, is stuck in its ways and needs a push in the right direction. Forcing programs to interview virtually and limiting students to one away could be the push we needed.
The virtual interview may be the great equalizer to some degree. My peers have interviewed in Los Angeles, Miami, Chicago, Seattle, when they would have never taken the chance because flights and hotels are expensive.
These peers are brilliant scientists and compassionate leaders who will one day be life-changing physicians. The schools beyond their typical reach would be lucky to train them.
But what about the mental burden of overthinking Zoom lighting and audio quality, of the ever-present risk of technical difficulties and lost internet connections, of choosing a future home without stepping foot on site, without a single handshake? Equalizer yes, easy no.
Force for good?
At the end of the day, is virtual our new normal? Did we choose correctly? Did we use our technological aptitude for good? Like any other marriage, we pick residency programs for better or worse. Sitting at the end of the interview season, tired of staring at screens and adjusting lighting, I’m reminded that this is nearly the end of a long journey. Years of schooling and hours spent on resume-building, volunteering, research—all for this. As students, we shadowed, scribed, and nervously followed residents on rounds hoping that we had the right dressings in our white coat pockets. Now, we would be adding MD to our names and, with it, the very real responsibility for patients. While the remainder of our medical education has been relegated to online lectures and our board exams may have been delayed more times than we care to count, we’re ready.
When we walk through the hospital come July, the beginning of the end, I’ll be happy to see where this journey takes us—possibly to a place we would have never seen if not for a microscopic virus forcing our hand. The pandemic has been a challenge, but perhaps it imposed some equity on a process long due for a change.
Lauren Cralle, BS, is a medical student who will graduate in the Class of 2022 from University of Massachusetts Medical School.
