Psychiatry Residency Application in the COVID-19 Era: A Medical Student Conundrum

Psychiatry Residency Application in the COVID-19 Era:

A Medical Student Conundrum

Emma Batchelder, BSa; Taranjeet S. Jolly, MDb,*; Ankit Jain, MDb; and Ahmad Hameed, MDb

The severe acute respiratory syndrome coronavirus 2 novel coronavirus, which ultimately led to the coronavirus disease 2019 (COVID-19) pandemic, first emerged in China in December 2019 and has since spread across the globe.1 Since the outbreak began, there has been a significant disturbance in medical education, as curriculum delivery and advising have changed dramatically, particularly in psychiatry.2 Medical students have struggled to complete required rotations,2,3 participate in off-site rotations, and sit for licensing examinations.3 The ramifications of the pandemic on medical education are perhaps most severe for senior medical students who face significant challenges when applying for residency positions during the 2020-2021 cycle.3-5 Although there are publications6-9 focusing on residency applications in the era of COVID-19 in numerous specialties, inquiry into the impact on those applying for psychiatry residency positions is notably lacking. In this commentary, we detail the challenges that aspiring psychiatrists face in applying for residency positions during the 2020-2021 cycle in the midst of COVID-19 from the perspective of an American allopathic medical student.

The current pandemic has caused many substantial changes to the undergraduate medical education curriculum, including halting and restructuring of clinical rotations.2,3 Such restructuring has also greatly impacted the residency application process. Students have experienced modifications in both clinical clerkships2,3 and grading,3 potentially impacting their mental health,3,10,11 all of which may result in decreased academic performance.3,12 Decreased academic performance may impact the ability to perform highly on the United States Medical Licensing Examination (USMLE), as well as influence student’s Medical Student Performance Evaluation.3 Further, decreased performance in objective data may determine the number of interviews that applicants are offered and thus the number of programs available to rank. This is especially concerning for many psychiatry applicants, as the residency application process faces a significant surge in applications,13-15 and program directors are receiving more applications than in the past.13 Due to the increased number of applicants, it has been suggested that programs may have greater reliance on measures such a licensing examination scores to select interviewees.13 The average USMLE Step 1 score of US MD psychiatry matched and unmatched applicants in 2020 was 227 and 216, respectively, while the mean USMLE Step 2 score was 241 and 229, respectively.14 Unsatisfactory scores on these examinations may cause concern regarding the applicant’s ability to receive interview invitations, as 62% of program directors cited Step 1 and 76% cited Step 2 as important factors in selecting applicants.16 Fewer number of interviews may be of concern for many applicants due to the competitive nature of the psychiatry residency application process.

In addition to changes surrounding clinical rotations and grading, USMLE testing availability has starkly decreased since the pandemic outbreak. The USMLE examinations are key components of the residency application process.3 In the midst of the pandemic, there has been suspension and delay of examinations. The USMLE Step 2 clinical skills examination was suspended in May 2020 for a minimum of 12-18 months.17 Further, Step 1 and Step 2 clinical knowledge testing also faced scheduling delays and test site closures.18 The USMLE program has administered the Step 2 examination at numerous medical schools to expand testing availability.19 Although this solution may not meet the needs of all students, additional testing options may alleviate some stress as psychiatry residency hopefuls prepare for the application cycle.

In addition to suspension of licensing examinations, there have been dramatic modifications to interview formatting and availability as a result of COVID-19 regulations. The Coalition for Physician Accountability’s Work Group on Medical Students in the Class of 202120 recommended that all residency programs conduct virtual interactions for the 2020-2021 cycle. Further, the Association of American Medical Colleges has offered guidance and virtual interview tips for prospective applicants.21 Virtual interviewing may prevent applicants from truly getting to know a program, the geographic area, and potential future colleagues. Although the virtual interview may be a significant challenge to some, many program directors have worked to overcome this barrier by hosting virtual events, wherein applicants may ask questions, meet with residents and faculty, and learn about programs.22 Interestingly, virtual interviews may yield a silver lining in terms of finances for many applicants. A 2016 study23 determined that 64% of applicants surveyed spent at least $2,500 on interview costs, while 13% spent $7,500 or more.23 Virtual interviews will not require the same travel expenses as conventional interviews and thus may decrease the total financial burden on applicants in terms of both the residency application process and total debt incurred.

Over the years, there has been an increase in number of US medical graduates applying for psychiatry residency positions.13 According to 2020 National Resident Matching Program (NRMP) data,24 there were 310 psychiatry residency programs with 1,858 available positions. Of 1,314 US MD senior applicants, only 1,138 were matched,24 leaving 176 (13.39%) applicants unmatched—a stark contrast to past years. As a comparison, in 2012, there were 1,118 available positions and 680 US senior (fourth-year medical students in Liaison Committee on Medical Education-accredited US allopathic medical schools) applicants with 616 matches,15 leaving 64 (9.41%) applicants unmatched. In 2020, NRMP data show that the mean number of continuous ranks in matched seniors is 11.0, while unmatched seniors ranked 5.3 contiguous programs.14 Such statistics may lead senior medical students to apply to a greater number of programs due to fear of not matching during this challenging year. The influx of applications will most likely increase the number of applications that programs receive, thus requiring programs to become more selective in inviting applicants to interview. To cope with the urge to apply to more programs during this application cycle, it is of upmost importance for applicants to reflect on their goals and evaluate the application requirements for each program to which they apply.

The 2020-2021 residency application cycle will greatly influence the future of the residency application and match process. Students are faced with countless hurdles, including changes to clinical rotations, difficulty completing licensing examinations, virtual interviews, and personal expectations regarding number of applications to submit. Despite these challenges and uncertainties, the 2020-2021 application cycle is one in which applicants and programs will undergo immense growth and development. Applicants must carefully reflect on their personal and professional goals, abilities, and shortcomings, while learning new interview skills. Programs must determine both preferred and non-negotiable applicant characteristics, navigate a potentially greater number of applications, and host virtual interviews. The age of COVID-19 has yielded a number of challenges for applicants to psychiatry residency programs, but there is opportunity for growth, as applicants will hone skills of perseverance, communication, and stress management—characteristics that will undoubtedly form a generation of adaptable psychiatrists.

Received: October 6, 2020.

Published online: December 17, 2020.

Potential conflicts of interest: None.

Funding/support: None.

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aPenn State College of Medicine, Hershey, Pennsylvania

bDepartment of Psychiatry and Behavioral Health, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania

*Corresponding author: Taranjeet S. Jolly, MD, Department of Psychiatry, Penn State University-Milton S. Hershey Medical Center, 500 University Drive, Hershey PA 17033 ([email protected]).

Prim Care Companion CNS Disord 2020;22(6):20com02831

To cite: Batchelder E, Jolly TS, Jain A, et al. Psychiatry residency application in the COVID-19 era: a medical student conundrum. Prim Care Companion CNS Disord. 2020;22(6):20com02831.

To share: https://doi.org/10.4088/PCC.20com02831

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