The unique impact of COVID-19 on orthopedic surgery residency applicants and program directors in Canada

Cancellation of visiting electives

The visiting elective allows both applicants and program directors to informally assess the applicant’s fit for that specific learning environment. Some groups of applicants may be disproportionately affected by the changes due to COVID-19: students who became interested in orthopedic surgery later in training, those with a less competitive portfolio, and international medical graduates may be unable to level the playing field by displaying positive personality attributes on visiting electives. Though all residency programs across Canada provide excellent training in orthopedic surgery, there are slight variations in education style; institutional objectives; faculty phenotype; and clinical volume, exposure and practice patterns that result in better or worse fits for different trainees.2 Trainees make subjective judgments of resident collegiality, program fit, resident–staff interactions, and potential red flags and weigh these in their eventual decision when ranking programs.3

Ongoing initiatives

In response to the cancellation of visiting electives, the AFMC advised on best practices for virtual engagement and applicant selection (Table 1) and launched a novel online tool in November 2020. The tool is for residents, faculty and program directors to schedule upcoming events, collate links to other relevant websites and post multimedia content about the program. It may be useful as a sustainable long-term program outreach tool, particularly for smaller programs that may not attract students on electives.

An analysis of orthopedic surgery residency programs’ use of online and social media tools is found in Table 2. As of Jan. 16, 2021, 12 orthopedic surgery programs had scheduled virtual program information nights. Virtual events consisted of town hall presentations and breakout rooms, with residents or faculty answering applicants’ questions. Additionally, a group of medical students organized a series of virtual panel seminars featuring 12 Canadian orthopedic surgery program directors. The seminars served as an effective platform for senior Canadian medical students with an interest in orthopedic surgery to meet program directors virtually and glean insight into each participating residency program. In the panel sessions, program directors recommended that applicants seeking to increase their knowledge and visibility to programs start by emailing residents and joining virtual academic half-days or journal clubs. Applicants reported that they enjoyed breakout room sessions with residents, which allowed them to observe resident interactions. Using these seminars as a platform for further growth and collaboration among participants, the same students then launched the Canadian Orthopaedic Surgery Interest Network (COSIN) page with the objective of fostering a community of interconnected medical students and sharing learning opportunities specific to orthopedic surgery.

Applicant strategies

Students should attend virtual learning events and use online tools to learn about programs. Programs may inquire about how applicants spent their time while not in the hospital because of COVID-19, and students should be prepared to answer these questions in a meaningful way. Students may also consider contributing to volunteer efforts to help the hospital or community; examples include sewing masks or creating other personal protective equipment, participating in telehealth or COVID-19 hotlines, or assisting with medical school education. Applicants can also seek opportunities to assist with ongoing research projects. Regardless of the subject matter, research is a means for applicants to exhibit intellectual curiosity, dedication to scientific investigation, critical analysis skills, leadership capabilities, perseverance and the ability to work within a team. Programs with more of a research emphasis may preferentially consider research experience.8

Programs

Programs should host virtual events featuring presentations by faculty and breakout rooms with current residents to give applicants a feel for the culture of a program. Programs can maintain an active virtual presence using social media, videos and podcasts via the AFMC online tool to feature the unique aspects of a program and highlight the achievements of faculty and residents. Programs can encourage attendance to virtual learning events, such as daily teaching rounds and journal clubs. Programs should consider accepting letters of recommendation from community and nonorthopedic surgeons. Programs can be transparent with the selection criteria of all application components, including interviews. Virtual interviews should involve assessment by a diverse group of residents and faculty, ideally using multiple mini-interviews or several rounds of interviews.

Applicants

It is recommended that applicants attend the virtual events of multiple programs and reach out to current residents at programs of interest. Applicants should utilize the online and social media tools available to learn about different residency programs. Applicants can participate in research projects to strengthen their CaRMS applications and engage in extracurricular activities that display leadership, collaboration and altruism.

An unintended benefit of COVID-19?

One may consider that the eradication of visiting electives (estimated $2000 per rotation) and in-person interviews (estimated $7000 for interview season) offers some financial benefit to students. Future qualitative research should be directed toward assessing the phenomenological experience of applicants and program directors throughout the residency application process.