Virtual or In-Person? A Census of Orthopaedic Surgery Residency Interview Formats for Match 2025

Authors: Darin Friess, Eden N. VanderHoek, Ruth Carver Bondurant, Ryan Christ, Molly Joyce, Sydney Laxson, Zoe K. VanderHoek, Haley D. Smith, Katherine Velicki, Kenneth Gundle

Abstract

Background:

Since the Match began in 1952, residency interviews were traditionally conducted in person. This abruptly changed in 2020 when virtual interviews became mandatory. In 2024, the Association of American Medical Colleges (AAMC) recommended retaining the virtual format. However, the Council of Orthopaedic Residency Directors left interview formats up to individual programs for the 2024 to 2025 cycle. This study examined what format orthopaedic surgery residency programs chose to interview their candidates for the 2024 to 2025 interview season.

Methods:

The list of orthopaedic surgery residency programs in the United States was compiled from the AAMC Electronic Residency Application Service Directory website. Each program’s interview format (virtual, hybrid, or in-person) was detailed using the Orthopaedic Residency Information Network, individual program websites, and direct communication with program coordinators. Programs’ geographic locations (state and region) and class size (small <4, medium 5-8, and large ≥9 residents) were also recorded.

Results:

Interview format data were obtained for 182 of 198 (92%) total orthopaedic surgery residency programs. Of these, 128 programs (70%) held in-person interviews, while 46 (25%) opted for virtual and 8 (4%) used a hybrid format. There was high variability in interview choices across states, ranging from all in-person interviews to exclusively virtual interviews (p = 0.03). Interview formats varied slightly by region. The West (43%) held a higher proportion of virtual interviews than the Northeast (27%), Midwest (21%), Southeast (23%), or Southwest (16%). However, regional differences were not statistically significant. Finally, programs with small class sizes conducted virtual interviews (38%) more frequently than medium (13%) or large (0%) programs (p = 0.002).

Conclusions:

Orthopaedic surgery residency programs favored in-person interviews in the 2024 to 2025 interview season. Program state and class size were associated with choice of interview format, whereas regional differences were not statistically significant.

Introduction

Since the Match was established in 1952, residency interviews in the United States were traditionally conducted in person^1^. This abruptly changed in 2020 when the Coalition for Physician Accountability mandated that all residency programs conduct interviews virtually for the subsequent application season^2^. Abiding by institutional and federal travel restrictions during the COVID-19 pandemic, orthopaedic surgery residency programs turned to virtual interviews to maximize applicant and program safety.

After the federal COVID-19 public health emergency ended in May 2023^3^, residency program leaders were left with a choice between maintaining virtual interviews or returning to the in-person format. In the summer of 2024, the Association of American Medical Colleges (AAMC) issued a recommendation for virtual interviews, citing applicant convenience, lower costs, and smaller carbon footprints as some of the biggest advantages of this format^4^. However, this recommendation was not a requirement; the AAMC ultimately left interview format decisions up to individual programs. The Council of Orthopaedic Residency Directors (CORD), a division of the American Orthopaedic Association (AOA), formally recommended that individual programs be allowed to choose between in-person or virtual interviews as best met their needs^5^. The CORD did discourage hybrid interviews, likely to maximize fairness when comparing applicants from the same match cycle.

Although orthopaedic surgery residency programs were encouraged to post their chosen interview formats on the AOA Orthopaedic Residency Information Network (ORIN), the information in this database was not comprehensive^6,7^. In addition, neither the AAMC nor any other group has published data about how residency programs chose to interview candidates recently. This project was designed to provide a current census of orthopaedic surgery residency interview formats in the United States for the 2024 to 2025 application cycle. The study also examines whether program-specific features, including class size and geographic location, are associated with the choice of virtual or in-person interviews. Finally, our work provides a broad view of how residency interview format choices in orthopaedic surgery compared with other popular specialties leading up to Match 2025.

Methods

To answer the question of how orthopaedic surgery residency programs are choosing to interview their applicants, our team designed a census. In the fall of 2024, a single researcher compiled a list of United States orthopaedic surgery residency programs participating in the 2024 to 2025 application season from the AAMC Electronic Residency Application Service Directory website^8^. Allopathic and osteopathic residencies were included. Military programs and those located in Puerto Rico were excluded.

The researcher then used the ORIN database, direct correspondence with program coordinators, and individual program websites to determine whether each program conducted virtual, hybrid, or in-person interviews for the 2024 to 2025 season. All hybrid formats were described in detail and reviewed by the lead author to reduce ambiguity. In addition, the researcher recorded information about each program’s class size and geographic location (city and state). Residency class sizes were categorized as small (<4 residents), medium (5-8), or large (≥9). Each program was assigned to a region based on the 5-region model of the United States: West, Southwest, Midwest, Northeast, or Southeast^9^.

The primary outcome of this census was the proportion of orthopaedic surgery residency interviews that were conducted in virtual, hybrid, or in-person formats nationwide for Match 2025. Secondary outcomes included whether a program’s class size or geographic location (state and region) was associated with its choice of interview format. Finally, our group conducted a similar census across 22 other specialties; this allowed for comparison of interview format decisions in orthopaedic surgery with those in other residency fields.

Project design was reviewed by a statistician prior to execution. Pearson χ^2^ tests were conducted to determine whether interview format trends by state, region, and class size were statistically significant.

Results

One hundred ninety-eight orthopaedic surgery residency programs met inclusion criteria. Sixteen (8%) interview formats remained unknown and were excluded from analysis. Of the remaining 182 (92%) programs, the majority (128, 70%) conducted in-person interviews, followed by 46 (25%) with virtual and 8 (4%) with hybrid formats (Fig. 1). The hybrid format almost universally meant that programs offered the choice of either virtual or in-person interview dates to applicants. Sources used for determining interview formats were correspondence with program coordinators (70, 38%), the ORIN database (37, 20%), and program websites (75, 41%).

Interview formats varied by state (Fig. 2). In-person interviews were favored in many states. Meanwhile, there were 5 states in which programs only conducted virtual interviews. These interstate differences were statistically significant (p = 0.03).

Interview formats were also examined by geographic region (Fig. 3). Programs in the West had the highest proportion of virtual interviews (10, 43%) and the lowest proportion of in-person interviews (13, 57%). By contrast, in-person interviews were most prevalent in the Southeast (30, 75%), Midwest (36, 75%), and Southwest (14, 74%). These regional differences were not statistically significant (p = 0.4).

In addition, interview formats varied by program resident class size (Fig. 4). All programs with large class sizes conducted in-person interviews (4, 100%). Most (71, 83%) medium-sized programs also interviewed in person, while few opted for virtual (11, 13%) and hybrid (4, 5%) formats. Programs with small resident class sizes had the highest rates of virtual interviews (35, 38%), although most of these programs still held in-person interviews (53, 58%). These differences were statistically significant (p = 0.002).

Finally, when compared with 22 other residency specialties included in our study, orthopaedic surgery held the 4th highest proportion of in-person interviews (Fig. 5). The specialties that most favored in-person interviews were otolaryngology (86%), plastic surgery (85%), and neurosurgery (85%). By contrast, most programs in other residency specialties conducted virtual interviews for Match 2025.

Discussion

Residency interviews have undergone substantial changes in the wake of the COVID-19 pandemic. As society equilibrates after these tumultuous years, the field of medicine has an important question to virtual or in-person?

The primary finding of this study is that most orthopaedic surgery residencies have returned to in-person interviews. This preference conflicts with the AAMC recommendation for virtual interviews. However, the rarity of hybrid interviews shows high compliance with the 2024 CORD guidelines.

In addition, our work demonstrated high state-by-state variability in interview formats, with the highest proportion of virtual interviews in the West. It is possible that institutional policies may have favored the virtual format more in this region than others. We also found that small programs were more likely to interview virtually than medium and large programs. Programs in large cities may be easier for applicants to visit in person than rural programs. Holding in-person interviews on the same day may also help programs in the same large city narrow their pool of applicants. Finally, when compared with other popular specialties, orthopaedic surgery had the 4^th^ highest percentage of in-person interviews. The transition of many surgical subspecialties back to in-person interviews corresponds closely with individual society guidelines. Residency program director associations in otolaryngology, plastic surgery, and neurosurgery issued statements recommending in-person interviews in the summer of 2024.

Orthopaedic surgery’s transition back to in-person interviews has many implications worth considering. First, the orthopaedic surgery residency interview process is now very different from most other specialties in medicine. This high variability in residency interview formats complicates what used to be a uniform process for applicants as they decided the path of their careers.

Second, even after preference signaling, orthopaedic surgery residency applicants currently attend an average of 11 interviews^10^. Physically traveling to each of these interviews limits clinical learning time and is costly for medical students. Several studies have estimated that orthopaedic surgery applicants spend around $5,000 on residency interview travel when held in person^11,12^. In 2016, Fogel et al. reported that 72% of their surveyed orthopaedic surgery applicants borrowed money to finance their interview costs^11^. In a world of rising tuition, declining orthopaedic surgeon compensation, and uncertainty around Public Service Loan Forgiveness Program, should we be working as a field to limit applicant spending to only what is necessary for a quality match?^13-15^

Third, there is a growing environmental cost of traveling. Earth surpassed 1.5°C of warming above the preindustrial average for the first time in 2024^16^. The Paris Agreement in 2015 sought to limit warming below this level^17^. Flying is a very carbon-intensive activity. When residency interviews were universally virtual, Hampshire and colleagues surveyed 253 fourth-year medical students to quantify carbon emissions avoided with the new interview format. They found that the average residency applicant emits 4.31 tons of carbon dioxide (CO2) when traveling to all in-person interviews^18^. Extrapolated to the 1,590 applicants who applied for orthopaedic surgery residency in Match 2025, each in-person interview cycle emits around 6,853 tons of CO2. That is the equivalent of burning about 700,000 gallons of gasoline.^19,20^

Despite some advantages of the virtual format, there may still be value in face-to-face residency interviews. In a 2022 survey study by Mun et al., orthopaedic surgery residency program directors were split between favoring (39%) and opposing (47%) virtual interviews. Almost half expressed willingness to forego AAMC guidelines on this issue^21^. Another study by Brueggeman and colleagues in 2021 reported similar findings. In their sample, most candidates (81%) and program directors (79%) in orthopaedic surgery favored in-person interviews^22^. Commonly cited disadvantages for the virtual format include more difficulty assessing communication skills and “fit,” missing out on exploring a program’s location, and fewer opportunities to interact with residents and faculty^23^.

This study has several strengths. Before its execution, a census of residency interview formats in orthopaedic surgery had not been published. Program features associated with interview choice, as well as comparison with other specialties, had also not been studied prior to this work. Therefore, our census fills an important knowledge gap. In addition, the relatively high completion rate (92%) increases confidence that the census provides an accurate look at current interview practices in orthopaedic surgery.

There are several weaknesses to acknowledge. First, a researcher relied on 3 different sources to determine interview formats, introducing a risk of information bias. Some program-specific nuances, such as different interview formats for home students and away rotators, were not captured in this study. Institutional graduate medical education policies that may have influenced interview choices were also not explored.

Conclusion

Unlike most other specialties, most programs in orthopaedic surgery returned to in-person interviewing for Match 2025. Programs with small class sizes, in certain states, and with locations in the West were more likely to offer virtual interviews than peer institutions. The authors hope that the results of this study will inform stakeholders and policymakers as they shape the future of residency interviews in years to come.