key: cord-0820125-3ssri5nf authors: Tseng, Jennifer title: How Has COVID-19 Affected the Costs of the Surgical Fellowship Interview Process? date: 2020-05-20 journal: J Surg Educ DOI: 10.1016/j.jsurg.2020.05.018 sha: a505fcf5c17d2b7d286074d5a82899286f6e7335 doc_id: 820125 cord_uid: 3ssri5nf OBJECTIVE: To evaluate the effect of COVID-19 on the costs of the surgical fellowship interview process. DESIGN: A literature review of the historical costs of surgical fellowship interviews and a summary of how the shift to virtual interviews has unintended positive and negative effects on costs for applicants and training programs. RESULTS: Transitioning fellowship interviews to virtual platforms affects expenditures of finances and time. Each fellowship candidate saves close to $6,000 in interview travel expenses. Applicants require less time off from their residency programs during this critical time of need for frontline healthcare workers. However, applicants miss some of the live aspects of interviewing, and training programs invest more effort upfront altering their interviews to virtual formats. CONCLUSIONS: The COVID-19 public health crisis has had a significant impact on surgical education, including how selection is conducted. Virtual recruitment has the potential for cost savings but should continue to be refined. This is an opportune time to innovate and rethink how to recruit prospective surgical residency and fellowship candidates during the current and forthcoming interview seasons. The COVID-19 pandemic has had an unprecedented impact on surgical residents and fellows. Rotation and didactic schedules have been modified, trainees have been redeployed, and innovative use of technology has been explored for patient care and trainee education. 1 Though an applicant's financial expenditures vary depending on the individual candidate, fellowship program and even geographical locations of both, 9 there are published surveys that help guide an estimate of the economic burden of surgical fellowship interviewing ( Table 1) . As only two studies provide information about the monetary cost of fellowship interviews, additional reviews were performed of articles focusing on residency interview costs. [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] Although limited by their retrospective nature and usual survey response rate biases, the aggregated information demonstrates the expensive nature of fellowship interviews. An interviewee would have spent approximately $6,000 for live interviews applying for surgical fellowships in 2020, adjusting for inflation. Over fifteen hundred residents from surgical specialties applied for fellowships in 2019. If there are a comparable number of fellowship applicants in 2020, the cumulative saved cost of not having live interviews would be $9 million ($6,000 x 1,500 applicants), though that total needs some correction as there are fellowship applicants who interviewed in person before the implementation of social distancing measures. A prior survey of General Surgery Program Directors also revealed the substantial program costs of in-person recruitment. 23 There are around six hundred General Surgery subspecialty fellowships nationwide. Mean hard costs, not including personnel effort, is approximately $8,400 as adjusted for inflation. The cumulative financial savings for institutions presuming they held interviews after the start of social distancing is over $5 million ($8,400 x 600 programs) and more when accounting for non-General Surgery subspecialty fellowship programs. found that in addition to technical difficulties, applicants expressed concerns about the limited number of faculty interviewers and inability to view the hospital; they also missed observing how surgical faculty and trainees interact. 26 Healy et al. reported that while in the minority, 15% of candidates who participated in videoconference interviews for adult reconstruction fellowship at Newton-Wellesley Hospital's Kaplan Joint Center between 2015 and 2017 did not feel they presented themselves to their satisfaction, 19% were not comfortable ranking the program, and 34% stated that videoconference interviews had an unfavorable impact on their ranking of the program. 24 These studies demonstrate that despite the reduction in financial spending, there are less quantifiable costs to applicants' abilities to convey themselves and assess a program with virtual recruitment. With COVID-19, virtual interviews have been a necessary adjustment for fellowship training programs in match seasons, and they may be the future of residency and fellowship recruitment. With the Association of American Medical Colleges reporting median graduating student debt of $200,000 in 2019, virtual interviews advantageously reduce additive costs to preexisting economic hardship. 27 They minimize surgery resident absences from their training programs. Virtual interviews may be utilized in a two-tiered screening program to narrow applicant pools and host candidates who have greater interest in the program. [24] [25] [26] Nevertheless, there are concerns about the equivalency of virtual interviews to live recruitment. Thus, recommendations for improvement opportunities:  Surgery programs should work closely with faculty and staff to become more facile with videoconferencing to diminish loss in productivity secondary to unfamiliarity or discomfort with technology. 25 They can use web streaming or pre-produced videos to highlight traditionally unique "live" aspects of interview days like the campus and city tour. 24 Websites can be supplemented with narrated slide decks and podcasts to save on hard copy or emailed reproductions of program materials usually prepared for applicants.  Further centralization of fellowship virtual interviews using uniform platforms may streamline processes for candidates and programs.  Fellowship candidates and faculty members should prepare for virtual interviews as they would for live interviews to maximize the use of time. 28, 29 Fellowship programs should help accommodate applicants whose home environments may not be appropriate for professional interviews or who may need modifications of their interview days due to clinical responsibilities during the COVID-19 pandemic and recovery. 30  Ongoing applicant and program surveys are needed to learn more about the cost benefits and disadvantages of the widespread use of virtual interviews. As the global impact of the COVID-19 public health crisis continues to evolve, so must thinking about all aspects of surgical education, including how selection is conducted. The unintended effects on costs make this an opportune time to innovate and rethink how to recruit prospective candidates during the current and forthcoming interview seasons. Residency and Fellowship Program Accreditation: Effects of the Novel Coronavirus (COVID-19) Pandemic Using Technology to Maintain the Education of Residents During the COVID-19 Pandemic National Resident Matching Program: Participating Fellowships The Fellowship Council: Directory of Fellowships Financial and educational costs of the residency interview process for urology applicants Current Interview Trail Metrics in the Otolaryngology Match. Otolaryngol Head Neck Surg Digging into Debt: The Financial Burden Associated with the Otolaryngology Match. Otolaryngol Head Neck Surg The Economic Burden of Residency Interviews on Applicants The Economic Burden of Orthopedic Surgery Residency Interviews on Applicants The Cost of Getting Into Orthopedic Residency: Analysis of Applicant Demographics, Expenditures, and the Value of Away Rotations Financial burden associated with the residency match in neurological surgery Survey of Applicant Experience and Cost in the Urology Match: Opportunities for Reform Is the orthopedic fellowship interview process broken? A survey of program directors and residents The Burden of the Fellowship Interview Process on General Surgery Residents and Programs The plastic surgery match: predicting success and improving the process Residency interview video conferencing Integrated plastic surgery residency applicant survey: characteristics of successful applicants and feedback about the interview process Association of American Medical Colleges: Cost of Applying to Residency Questionnaire Report How Much Are We Spending on Resident Selection? Videoconference Interviews for an Adult Reconstruction Fellowship: Lessons Learned Randomized evaluation of a web based interview process for urology resident selection Efficacy of Videoconference Interviews in the Pediatric Surgery Match Association of American Medical Colleges: Medical School Graduation Questionnaire Virtual Interviews in the Era of COVID-19: A Primer for Applicants Videoconference Interviewing: Tips for Success Feasibility and Usability of Teleinterview for Medical Residency Interview Surgical Fellowship Interview Seasons Affected by COVID-19 Student applicants in the 2015 residency match Neurosurgery Mean ± SD: $6,930 ± $ 778 Range: $1 Plastic Surgery Mean ± SD: $4,750 ± $2,050 Range: $1 General Surgery Mean ± SD: $4,264 ± $2,670 Range: $810 -$ $3,500 ± $1,979 Range: $900 -$