In a typical year, medical students commissioned in the United States Army, applying to match in emergency medicine, prepare to visit and interview at four programs spread across the country.
This time functions as a vital, interactive 2-4 week-long interview in which both student and program can assess each other to form a synergistic match. In-person experience allows for holistic understanding of education, hospital setting, residency culture, and opportunity at each program.
This was not a typical year.
The military started to impose travel restrictions as a result of the widespread COVID-19 pandemic only a few months before interviews began. Medical students and program leadership were left unsure if there would be any meaningful interaction in the coming year. As a student involved in this military match, I interviewed 15 of my peers to get their perspective in order to share this unique experience and hopefully learn from the successes and challenges it presented.
Programs reacted quickly to the changing landscape. While uncertainty loomed, two programs specifically opened their virtual doors and invited us not only to sit in, but also to engage in their didactics. "Opening up grand rounds on Zoom for prospective students was a fantastic resource," a student stated in an interview. One program created an entire curriculum experience termed "Medical Student Mondays". During these sessions, students engaged in an emergency medicine-specific topic with residents and faculty. "It wasn't just a chance to interact, but an opportunity for prospective students to see how the program functions," another student remarked.
In addition to innovative virtual experiences, individual program leaders went above and beyond for this year’s interviewing class. Dr. Mark Riddle from the Carl R. Darnall Army Medical Center and Dr. Gillian Schmitz from Brooke Army Medical Center were celebrated by nearly every medical student I came in contact with. They were referred to as "huge game-changers" and it was noted that they "worked really hard to give us all an equal playing field." "I have heard many other students say that they were calm because of those two," one student summed up. Along with resources like Government Services EMRA (GS-EMRA) and Facebook, both names were at the top of everyone’s list when asked how they stayed informed during the myriad of changes that plagued the months leading up to the interviewing season.
Intertwined with the bright spots, there were also significant challenges that this cohort of students faced. Students that were limited by their university on the number of away rotations were six times more likely to feel disadvantaged by the whole process. When asked if COVID will affect the match results, one student who felt that they lacked support from their school said, "A hundred percent! There is no way not to. How are you supposed to have an equal playing ground?" In addition, some students felt they had an advantage because their school was supportive. In contrast, however, more than half reported that they believe COVID would unlikely affect the overall results. Students with school support mostly acknowledged the discrepancy, "If my school had been different, I think all of my answers would be changed," one student commented.
Another prominent challenge was finding the right person to connect with at each program. Students felt that gaining access to the programs and getting on the right email list was the rate-limiting step to overall success in scheduling rotations and feeling informed as changes occurred. One student referred to this as the "biggest barrier." Another HPSP student put bluntly, "Once I got on the right lists and got in with the right people everything was good. It was hard to get to that point." Students on the Health Professions Scholarship Program (HPSP) have minimal resources or channels of information universally distributed making it difficult to navigate even in a normal year. Since communication was of the utmost importance during a year clouded by a pandemic, programs that were slow to respond generated a significant negative image to some.
Finally, the loss of cultural, out-of-hospital interaction with the current residents was lamented by 9 of the 15 students I interviewed. "You are choosing a family," one interviewee put simply. Most went on to admit this was just an unavoidable consequence of the situation we were in.
In the end, the most surprising theme from all of my interview sessions was a general feeling of positivity towards the process. It was clearly different and difficult. "I felt like a tumbleweed," one student described, but like the others, this student felt the programs not only did the best they could, but exceeded expectations. Statements like: "Everyone was pretty understanding about the situation we were in," and, "I never thought I was put in a position where I felt unsafe," were echoed by the vast majority of students and I felt the same way.
The COVID-19 pandemic is unique - however, the consensus showed it didn't necessarily present new challenges, but rather it amplified existing areas of weakness. "So many of the challenges were probably not even related to COVID," one student pointed out. When describing the difficulties of accessing a consistent line of communication from each program, another student astutely stated, "The year-to-year changes will be there, but that will stay the same." Even the variability of collegiate regulations can have an effect on a "normal" year, but with the additional decision administration was forced to make as a result of COVID-19, this effect appeared to be more pronounced.
This year gave us an opportunity to improve the process for the future. External committees such as GS-EMRA and GS-ACEP have started to act as a resource for program information. Colonel Maurer, the current Deputy Director for Army Graduate Medical Education of the HPSP program, has increased direct communication with students via Facebook, which was praised by most of our cohort. When asked which of the changes made this year should remain, one student said, “Engage students even before interview season starts...the more exposure the better.” This sentiment, regarding continuing to open virtual doors prior to audition season, was echoed by 8 other students.
Difficult situations tend to reveal who we are as a people and as a group. One student summed up the year by saying, "I think the way the programs handled it, and how the applicants handled it, is a positive about the military and emergency medicine." Both programs specialize in adaptability to the unknown. This mentality was certainly seen amongst both the students and the programs throughout a bizarre, unique, difficult, and revealing Match season.
Acknowledgments: Support given by the GS-EMRA Committee.
Disclaimer: The views expressed are solely those of the authors and do not reflect the official policy or position of the U.S. Army, U.S. Navy, U.S. Air Force, the Department of Defense, or the U.S. Government.