Keywords
residents - graduate medical education - interview - program director
Post-interview communication between applicants and residency program directors (PDs)
is time-consuming and can lead to mismatched expectations because residency applicants
may interpret positive language from PDs as a promise to be ranked to match.[1] In addition, PDs are left with the difficult task of interpreting and responding
to messages from applicants. In light of these challenges, some specialties have adopted
policies that discourage or prohibit routine “thank you” notes or emails from interviewed
applicants ([Supplementary Table S1]).
Currently, the Ophthalmology Matching Program (OMP) has no policy regarding post-interview
communication between ophthalmology residency program faculty and residency applicants.
The Association of University Professors of Ophthalmology (AUPO) specifies that programs
should not initiate contact with applicants until the match is completed, but has
no official policy with regard to communications initiated by applicants. The paucity
of guidelines on post-interview communication may result in inconsistencies in communication
practices that expose the ranking process to unintended factors. For instance, applicants
and/or faculty may be misled by communications that exaggerate interest from the other
party. Despite the potential impact of post-interview communication on match outcomes,
little is known about its use and influence on PD and applicant ranking behaviors.
This study investigated the preferences and practices of U.S. ophthalmology residency
PDs regarding post-interview communication during the residency match period and the
impact of such communication on PD ranking of applicants.
Methods
The Brown University Institutional Review Board granted an exemption for the study.
We administered an anonymous survey to all 116 U.S. ophthalmology residency PDs on
current practices and preferences regarding post-interview communication during the
application cycle. To our knowledge, there have not been any validated or previously
used surveys on PD preferences regarding post-interview communication. Hence, the
authors designed the survey instrument and then revised it based on input from two
experienced ophthalmology PDs. The survey instrument ([Table 1]) was administered using online survey software (Qualtrics, Provo, UT) licensed to
Brown University.
Table 1
Post-interview communication survey results (N = 74)
|
Question
|
No. (%) of program directors
|
|
Which statement best describes your preferences about applicants and program directors
communicating during the post-interview period?
|
(N = 73)
|
|
I prefer that applicants and program directors communicate during the post-interview
period
|
18 (25%)
|
|
I prefer that applicants and program directors do not communicate during the post-interview period
|
55 (75%)
|
|
If response 2 is selected: Please select all statements about why you do not prefer applicants and program directors to communicate during the post-interview
period:
|
(N = 55)
|
|
Communication in the post-interview period takes too much time
|
19 (35%)
|
|
Communication in the post-interview period is not ethical
|
31 (56%)
|
|
Communication in the post-interview period is not productive
|
31 (56%)
|
|
There are other reasons I do not prefer post-interview communication:
Summary of responses: Unethical/misleading (8), Does not affect ranking (3), Blank
response (3)
|
14 (25%)
|
|
If applicants contact you during the post-interview period, what do you like this
communication to contain? (check all that apply):
|
(N = 74)
|
|
Reasons why the applicant thinks this program is a good fit for them
|
25 (34%)
|
|
Reasons why the applicant is a particularly good fit for the program
|
23 (31%)
|
|
If they are ranking my program no. 1
|
9 (12%)
|
|
Other (specify):
Summary of responses: Program-specific questions (4), Thank you (2), Other (1): Applicant
expectations
|
8 (11%)
|
|
None of the above; I do not want applicants to contact me during the post-interview
period
|
42 (57%)
|
|
If applicants contact you during the post-interview period, when do you prefer this
communication to be sent?
|
(N = 74)
|
|
Within the first 2 days after the interview
|
2 (2.7%)
|
|
Within the first week after the interview
|
15 (20%)
|
|
Before winter holidays
|
12 (16%)
|
|
Other (specify)
|
3 (4.1%)
|
|
None of the above; I do not want applicants to contact me during the post-interview
period
|
42 (57%)
|
|
Has post-interview communication with an applicant ever made you rank an applicant
higher?
|
(N = 74)
|
|
Yes
|
16 (22%)
|
|
No
|
43 (58%)
|
|
I have never communicated with an applicant during the post-interview period
|
15 (20%)
|
|
If yes: What has made you rank an applicant higher?
|
(N = 16)
|
|
Summary of responses: Genuine interest (7), Location restriction (4), Other (5):
additional positive information, potential impact on program
|
|
|
Has post-interview communication with an applicant ever made you rank an applicant
lower?
|
(N = 74)
|
|
Yes
|
15 (20%)
|
|
No
|
45 (61%)
|
|
I have never communicated with an applicant during the post-interview period
|
14 (19%)
|
|
If yes: What has made you rank an applicant lower?
|
(N = 15)
|
|
Summary of responses: Too much post-interview contact/aggressive (4), Tone of correspondence
(4), Neediness/begging (2), Other (5): Additional negative information, confirmed
interview concerns
|
|
|
Have you ever been misled by applicant communications regarding where the applicant
was planning to rank your program?
|
(N = 74)
|
|
Yes
|
53 (72%)
|
|
No
|
21 (28%)
|
|
Have you had at least one instance where an applicant communicated that he/she would
rank your program no. 1 when he/she did not?
|
(N = 74)
|
|
Yes
|
45 (61%)
|
|
No
|
29 (39%)
|
|
Do you think communication between applicants and program directors in the post-interview
period can help rank applicants?
|
(N = 74)
|
|
Yes
|
25 (34%)
|
|
No
|
35 (47%)
|
|
Don't know
|
14 (19%)
|
|
If applicants communicate with you during the post-interview period, do you reach
out specifically to those who are highly ranked?
|
(N = 74)
|
|
Yes, we reach out to those who are ranked to match (those ranked in the number of
spots that are available in my residency program)
|
1 (1.4%)
|
|
Yes, we reach out to those who are ranked within the number of spots that I historically
matched students (but greater than the number of residency spots available)
|
2 (2.7%)
|
|
No, we respond to most or all applicants who communicate with us, regardless of if
they are ranked highly or not
|
32 (43%)
|
|
No, we do not reach out to applicants
|
38 (52%)
|
|
Other
|
1 (1.4%)
|
|
PD opinions on current and future communication practices (
N
= 74)[a]
|
% of PDs who “Agree” or “Completely Agree” with statement (no.)
|
% of PDs who “Disagree” or “Completely Disagree” with statement (no.)
|
|
The current level of post-interview communication is excessive
|
47% (35)
|
18% (13)
|
|
If I do not respond to an applicant communication, it may send a false message that
I am uninterested in them
|
66% (49)
|
9% (7)
|
|
I find it difficult to respond in an appropriate manner to avoid misleading an applicant
regarding their rank status
|
49% (36)
|
32% (24)
|
|
The current post-interview communication system is ethical
|
26% (19)
|
32% (24)
|
|
Aside from logistical questions directed to the program coordinator, the Ophthalmology
Matching Program (OMP) should institute a policy of no post-interview communication
between applicants and faculty
|
62% (46)
|
22% (16)
|
a Those not represented by either of the two response columns responded with “Neither
agree nor disagree.”
Using publicly available email addresses from the American Medical Association's Residency
and Fellowship Database Web site, FREIDA Online, we emailed the survey, along with
a brief description of the study and its purpose, to all U.S. ophthalmology residency
PDs.[2] During the same week, we mailed a letter with the survey link along with a $1 incentive
to all the U.S. ophthalmology residency PDs. Weekly reminder emails were sent to nonresponders.
After the third reminder email, nonresponders received two phone call reminders, spaced
approximately 1 week apart. The survey was closed after 6 weeks. Identities of the
responders were dissociated from their answers to the survey. Nonresponders were tracked,
but this information was not linked to any individual responses. To assess for potential
nonresponse bias, each program was categorized into one of four geographic locations
(Northeast, Midwest, South, West)[3] and into one of three program sizes (6–11 residents, 12–14, and 15 + ),[4] and these characteristics were compared between the respondent and nonrespondent
groups. Data were analyzed using descriptive statistics.
Results
The response rate was 64% (74/116). Programs from the Northeast comprised 21% of respondents,
Midwest 26%, South 36%, and West 17%. Thirty-eight percent of programs had 6 to 11
residents, 30% had 12 to 14 residents, and 32% had 15 or more residents. There was
no difference in the distribution of geographic location (χ
2 = 3.05, p = 0.38) or size of program (χ
2 = 0.62, p = 0.73) between respondents and nonrespondents.
The results of the survey are summarized in [Table 1]. The majority (75%; 55/73) of PDs preferred no post-interview communication during
the residency match period with the main reasons being that such communication is
not ethical and not productive. The PDs indicated that, if they were to receive post-interview
communication from an applicant, they would prefer that the applicant communicate
why the program is a good fit for the applicant (34%; 25/74), why the applicant is
a good fit for the program (31%; 23/74), if the applicant plans to rank the program
first (12%; 9/74), and any program-specific questions (5.4%; 4/74).
Regarding post-interview communication and its potential effect on rank status, 21%
(16/74) of PDs stated that in at least one instance, post-interview communication
changed the ranking status of an applicant. The majority (71%; 53/74) of PDs reported
having been misled in post-interview communication(s) regarding applicant ranking
of the program, and 60% (45/74) of PDs reported at least one instance in which an
applicant falsely communicated that he/she would rank the PD's program first.
Two-thirds (49/74) of PDs were concerned that not responding to an applicant's query
would give the impression of a lack of interest in the applicant, and nearly half
(49%; 36/74) of PDs found it challenging to formulate responses that did not mislead
an applicant regarding his or her rank status.
While 34% (25/74) of PDs reported that post-interview communication helps rank applicants,
62% (46/74) of PDs indicated that the OMP should institute a policy of no post-interview
communication between applicants and faculty, except for logistical questions directed
from the applicant to the program coordinator.
Discussion
Results of this survey suggest that most PDs prefer no post-interview communication
between residency applicants and program faculty during the residency match period.
The PDs had several reasons for avoiding post-interview communication. They believed
it was time-consuming and neither ethical nor productive. In addition, nearly half
of PDs reported difficulty in responding to post-interview communication in an appropriate
manner. Equally important, PDs often have been misled by applicant communications,
including instances where applicants falsely communicated that they would rank the
PD's program first. This is an important concern and consistent with other studies:
52% of PDs from multiple specialties reported that, at least once a year, one or more
applicants falsely claimed they were ranking their program number first.[1] Similarly, several applicant surveys have shown that applicants often deliberately
exaggerate their interest in training programs.[5]
[6]
[7]
Post-interview communication may also impact residency applicants. First, our findings
suggest that applicants may be ranked higher or lower based on post-interview communication;
although an applicant's expressed interest, location preference, and additional positive
information can positively impact an applicant's rank, too much post-interview contact
and perceived aggressiveness or neediness may have the opposite effect. Second, residency
applicants often alter their rank order list based on communications with programs,[5] including raising the rank of programs that applicants perceive show higher interest
in them in the post-interview period.[6] Complicating these trends, up to one-third of surveyed applicants from multiple
specialties reported being misled by residency program leadership in post-interview
communication.[1]
The AUPO has several options to address issues surrounding post-interview communication.
Following the example of the American Council of Academic Plastic Surgeons,[8] the simplest option would be to institute a policy of no post-interview communication
between applicants and faculty (not including administrative queries directed to the
program coordinator) during the match period. By eliminating the temptation for abuse
and mistrust in post-interview communication, this approach would help level the ranking
playing field. Our survey suggests that 62% of ophthalmology PDs favor this approach.
As demonstrated by the Association of Program Directors in Internal Medicine (APDIM),
another option would be to design specific guidelines on what may be included in post-interview
communication. The APDIM recommends that programs refrain from sending routine “thank
you” messages to applicants after the interview period, limit communications to factual
pragmatic information sent to all applicants, and identify an approved contact who
will be the sole communicator with applicants.[9]
This study is limited by potential response bias. PDs may have been more inclined
to participate if they have had a prior experience with post-interview communication
that strongly impacted their match results. However, the 63.8% response rate achieved
in this study exceeds that of recent ophthalmology PD surveys (33–51%).[10]
[11] Furthermore, there was no significant difference between respondents and nonrespondents
with respect to program geographic location or size.
In summary, many U.S. ophthalmology residency PDs would welcome an official policy
from the AUPO regarding post-interview communication between applicants and programs
during the match period. The experiences of plastic surgery and internal medicine
demonstrate that national organizations representing academic ophthalmology and residency
applicants can work together to achieve this goal.
