This forthcoming resident match process must be designed and conducted in a manner that emphasizes ethics and professionalism, not only to secure the integrity of the process, but also as a reflection of the responsibility to model the best traits and virtues for those who will become the future of our specialty.
Explore This IssueSeptember 2020
Fairness. Second, will the pandemic-altered match process be one that’s beneficial for all of the stakeholders, including the applicant, the training program, the current and future resident cadre, the faculty, and the institution? Every training program in otolaryngology over the years has likely experienced a situation where the fit between a matched applicant and the training program hasn’t worked out beneficially. This can occur even without the limitations of a pandemic, but the forthcoming match cycle may present challenges that increase the risk of unsatisfactory matches. A poor fit between an applicant and a training program can have a long-term impact on both, with multiple ramifications for all of the stakeholders. Therefore, mitigation of risks is both an ethical and a professional obligation, one that is primarily placed on the training programs, because they hold the balance of power and are in charge of the mechanics of the match.
Mitigation. The third ethical principle is that of nonmaleficence. As in clinical situations, we have an obligation to not allow harm to any of the stakeholders, especially the applicants, through a faulty process. How could harm be done? Foremost, applicants might not have the opportunity to fully describe and present their personal attributes and professional capabilities during a limiting virtual interview process. One of the most important aspects of the previous in-person interviews has been the ability for a “connection” to occur among applicants, residents, and faculty. Informal discussions can often be revealing, not only in determining interpersonal compatibility, but also in finding common interests upon which relationships can be built. In the absence of the informal discussions of the past, it will be harder to get to know each other in a manner that could provide the applicant and program with the sense that this could be a good fit for each. This potential harm must be considered in the course of development of the format for virtual interviews, as well as any potential “signaling” process and post-interview communications. Additionally, if the program decides to utilize asynchronous questions for video response, the opportunity to determine the applicant’s ability to spontaneously consider and respond to a question during a discussion is lost. In contradistinction to facilitating sufficient information exchange during salient discussions, limiting the ability of applicants to tell the story of who they are could be detrimental to making the best decisions. Body language observations and inferences may not be possible. Technical difficulties with virtual interviews are always potential concerns and can place applicants at a disadvantage. This compromises nonmaleficence.
Of no less importance is the principle of social justice, wherein equity must be achieved throughout the entire match process. Programs must internally consider whether any applicants might be disadvantaged with the processes during the pandemic-altered match—on any basis. While virtual interviews may level the field financially across the applicant pool, other equity concerns might exist, including access to high-speed internet, clarity of computer cameras, risks that the applicant’s living quarters might not be as well appointed as others, that children or roommates in the home might interfere with the focus of the interview, and the availability of in-person visits to some applicants (external to the program’s institution) but not to others. Ex parte schemes that offer access to programs for a fee must be scrutinized for equity and ethical compromise. Every applicant must have similar access to programs without any type of discrimination acting as an impediment.
Advice to this author from an otolaryngology chief resident and a medical student who will participate in the match has also revealed cogent concerns from their perspectives. Unfortunately, there may be an increased emphasis this year on applicants’ objective data, causing a lost opportunity for them to get a feel for the program, its personality, and the faculty and residents with whom the matched applicant might be working in the near future. Social media information and blog sites may or may not be helpful for the applicant, but they will undoubtedly play a role in this match cycle, so validity must be verified. Selecting an applicant for the top rankings by the department, and likewise the applicants’ final rank list, are normally a combination of synthesized information gleaned from research and interviews amalgamated with a gut feeling of compatibility or reservations about a fit. Not always a primary consideration for the programs, but often quite important to the applicants and resident cadre, is whether there’s a sense that they will be able to work together as a functional and positive team to provide patient care and share responsibilities. Not having a formal opportunity for an applicant to get to know the resident cadre in a given program, and vice versa, can raise anxiety and may lead to inaccurate perceptions that could adversely affect the decision-making process.
This forthcoming resident match process must be designed and conducted in a manner that emphasizes ethics and professionalism, not only to secure the integrity of the process, but also as a reflection of the responsibility to model the best traits and virtues for those who will become the future of our specialty. You and your fellow faculty will need to provide as much assistance and information to your medical students as is allowed, and help them navigate the uncertainties and anxieties that have arisen. This is part of the faculty’s responsibility for teaching professionalism. Additionally, it’s possible that salutary improvements in future match cycles could result from thoughtful considerations and outcomes of this year’s unique match situation, especially in the context of ensuring ethical conduct and professionalism. Otolaryngology–head and neck surgery is a specialty highly regarded by the profession of medicine, and this is another opportunity to earn that respect.
With appreciation to Ben Hunter, MD, chief resident, and Max Feng, senior medical student, at the University of Texas Health Science Center at San Antonio for their helpful perspectives.