Wise Words – Fall 2021 Newsletter

Recruitment season is upon us! The General Surgery Residency team is hard at work preparing to interview applicants, having already completed one of five interview dates after receiving and reviewing over 1300 applications for our nine categorical positions for the 2022 Match. In addition to the reviews, we have held a number of themed “virtual open houses” to give applicants a flavor of our program and our people, and we have packed and sent “swag boxes” (care packages, of a sort) for interviewees to get an almost literal taste of St. Louis.  We are, as always, excited to see what this new recruitment season will bring!

 As noted, in August and September we hosted a series of three virtual open houses for potential applicants, giving them the opportunity to learn more from leadership, faculty, and residents about our program and living in St. Louis. Like last year, the resident-only Q&A times during these sessions were well-attended and offered applicants an authentic and less inhibited look at our program through the eyes of current residents. We received excellent feedback about these sessions last year, and while they have led to an expansion of the interview season to a time even before the applications are actually released to us for review, we believe these sessions put us on the radar screens of many excellent applicants who might not otherwise consider coming to Washington University/Barnes Jewish Hospital and/or St. Louis. In addition to our website (gsres.wustl.edu) and social media efforts (@WashUSurgRes on Twitter and Instagram), these virtual open houses have become a valuable asset to the recruitment process, and I foresee them continuing in the future, even if we eventually return to in-person interviews. We are now conducting other theme-based virtual open houses that were developed and organized by our residents for those lucky applicants selected to interview with us (96 applicants will be interviewed this year for our categorical positions) to offer closer looks at our diversity/equity/inclusion and women-in-surgery experiences from the perspective of our residents and faculty, and these have also been well-received thus far. The hope is that the applicants can better determine their “fit” with our Program and people, making them willing to commit to at least five years with us for their surgical and academic training.

 Yes, virtual interviews will continue to be the planned recruitment approach given the uncertainties in the setting of mediocre national vaccination rates and concerning new viral variants. This is despite the low local COVID hospitalization rates in St. Louis over the late summer and fall (now unfortunately increasing again) and our Department’s 100% vaccination rate. While this approach is consistent with most national interview recommendations, we made this decision to avoid in-person interviews earlier this year out of an abundance of caution to safeguard applicants, faculty, residents, and our patients. As such, the interview process will remain virtual for the 2021-2022 recruitment season, and I would not be shocked if this becomes the new normal for recruitment for the foreseeable future as access, costs, and interview efficiency are much improved through virtual interviews (but I can certainly testify to the fact that interview “Zoom fatigue” is real after a full day of these interviews!). 

One difficulty that we continue to face this year as alluded to in my introduction above is the continued growth in application numbers and the tremendous work required to review them holistically. “Signaling” from applicants has always been important in determining those applicants earnestly interested in our program. In the past, applicant willingness to type out the individual unique application for WashU was the truest signal of interest. With the introduction of digital universal applications through ERAS in 1995, the typewriter signal became negated with each program becoming just a box to “click” to forward on the universal application. Thereafter, travel time and financial commitment (and willingness to brave the occasional winter storm!) became our indicator of interest, and we would see up to 30% turnover in our in-person interviews each year. Now, with the move to virtual interviews, those in-person “signals” have been negated. For example, despite increasing our total interview slots last year in the face of pandemic uncertainties, we saw <5% turnover in interviews. (Was it “interview hoarding?” Applicant curiosity despite low interest in WashU/StL? Or just “why not?” that led to the lower turnover rate… the jury is still out as the national debate to settle on best interview approaches continues.) We hope that future changes in the application and interview experiences will mitigate these issues and better achieve applicant and program “fit.”

To that end, two new optional tools were introduced and are being piloted by the AAMC this year in General Surgery, Internal Medicine, and Dermatology: “Preference Signaling” and “Supplemental Applications.” The former allowed applicants to select up to five programs to which they wanted to underscore their true interest (“Safety” programs? “Reach” programs? Programs in a geographic destination of interest? – the use of the signals was up to the applicants.), giving residency programs an opportunity to connect with highly interested candidates whom they might otherwise have overlooked. We used these signals this year as tie-breakers and to be sure to give at least one extra review of the application from “signaling” applicants; but not everyone who was invited to interview signaled us, and not all signals received an interview invitation. Assuming the pilot is deemed successful and continues next year, we will take an academic approach to assess our experience to determine how best to use and interpret these signals in the future. As opposed to the signals showing us an applicant’s interest, the supplemental application offered a deeper and more personal insight into the applicants’ experiences, goals, and interests to perhaps better determine fit. Admittedly, these supplements added even more materials to our already overly burdensome review process, and they were cumbersome to review on a separate platform from ERAS, so without blending the information together into one application in the future, I am not sure the supplemental application added much benefit programs and applicants this year. That said, these efforts are a step forward in the attempt to stem the tide of continued overwhelming application numbers and their unintended consequences. As a PD, I would love to see limits placed (on applications and interviews), but I appreciate the potential consequences and free-trade limitations of those approaches.

Despite the difficulties we continue to face in the recruitment process in the face of pandemic uncertainties and burgeoning application numbers, we continue to be incredibly excited about the opportunities to shape the future of Surgery through bringing the best and brightest to St. Louis and Washington University. We have busy weeks ahead as we complete the recruitment season for 2022, but we are already thrilled and ready to welcome yet another talented group of interns for the 2022-2023 academic year.

As always, please take care of yourselves and each other!

Paul E. Wise, MD

Program Director, General Surgery Residency

Washington University in St. Louis School of Medicine

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