The COVID‐19 pandemic: Implications for the oral and maxillofacial surgery residency application process

Abstract

In order to abide by public health guidelines, the upcoming oral and maxillofacial surgery (OMS) residency application cycle requires logistical and practical adaptations as a consequence of the coronavirus disease 2019 (COVID‐19) pandemic. Currently, OMS programs are relying on institutional guidance as official recommendations from national dental organizations are lacking. Residency programs are adjusting their application processes to ensure the safety of patients, potential applicants, and OMS teams. With OMS residency deadlines beginning September 1, programs and candidates face a dilemma involving completion of dental school requirements, admissions testing, externships, and interviews. Standardized modifications by governing medical bodies are benefiting medical residency programs, 1 and similar adjustments for dental students can ensure a successful 2020‐2021 OMS residency application cycle. In light of COVID‐19, dental schools reassessed didactic and clinical curriculums. Administrators reevaluated competency‐based requirements and incorporated virtual learning into dental education. 2 Social distancing may limit clinical exposures and chair time for students. Other external factors, such as decline in patient volume, may impact the completion of more elective procedures. Due to these challenges, it is critical that dental schools define a unified approach to ensure completion of Commission on Dental Accreditation (CODA) recommended requirements and timely graduation for students in the 2020‐2021 academic year. A component of an application that is critical for a successful match is the National Board of Medical Examiners Comprehensive Basic Science Examination (CBSE). To abide by social distancing regulations, the CBSE has converted from a single‐day examination in August to an examination window through September. All scores are expected to be released beginning September 15. This schedule may restrict candidates from applying to programs with earlier deadlines and may limit candidates based on the competitiveness of their CBSE score. Residency programs may need to reconsider their deadlines to ensure the inclusion of all candidates in the selection process. Externships are immersive experiences at residency programs that may provide a more accurate representation of its scope and culture. In a recent survey, OMS residents reported an average of 5 weeks of externships completed prior to residency. Completion of an externship at their matched program was observed in 42% of respondents. 3 Frequently viewed as an “extended interview,” candidates may “fall in love” with a program on an externship or have an experience that changes their perspective about a previously interesting program. As a result of the COVID‐19 pandemic in March 2020, residencies suspended externships. In addition, some dental schools, who previously provided dedicated externship time, are not allowing accommodations. There will be significant variation in the completion of externships within the candidate pool. This aspect of the 2020‐2021 application may no longer be an equitable method of assessing a candidate's interest in programs and OMS. The Coalition for Physician Accountability (CPA), a cross‐organizational group of national medical organizations, released recommendations covering issues faced by medical school applicants and residency programs in the 2020‐2021 application cycle. The group evaluated the need for medical away rotations, which similarly take place over the summer and fall months. The CPA recommended that such rotations be discouraged for the 2020‐2021 academic year. 1 However, subinternships completed at home programs are encouraged by medical schools. 4 It would be sensible of OMS residencies to communicate unified recommendations to prospective applicants. Candidates may be encouraged to complete an externship at their home program, if allowed by their local health system, while avoiding participation in off‐site experiences. Defined, official recommendations from residency programs and national dental organizations would reduce stress among candidates and preserve the integrity of the application process. Due to the inability to participate in traditional externships, dental specialties have begun transitioning these experiences to a virtual platform. An oral medicine program created a virtual format for participants. Attendees received information pertaining to logistics, procedures, and consultations to replicate the insight gained during an externship. Both the externship director and participants reported positive satisfaction with the virtual platform. 5 OMS residencies can incorporate a similar platform for externships. Program directors can schedule potential applicants for individual meetings with faculty and residents to discuss the program, day‐to‐day activities, preferred attributes of residents, and to answer any pertinent questions. Invitations to virtual OMS lectures or grand round sessions may also foster interaction. Due to its accessibility, virtual externships may expose potential applicants to more programs than in previous cycles. Of equal importance, program directors may interact with a broader group of applicants and develop a refined decision of which applicants to interview. The interview process during the 2020‐2021 application cycle must be reconsidered due to travel restrictions and safety concerns due to COVID‐19. Recently, the CPA recommended that all medical residencies commit to virtual interviews. 1 Although interviews may be beneficial for both applicants and programs, the interaction is often seen as a potentially inauthentic representation. This may be magnified due to COVID‐19, as a virtual platform may restrict genuine interaction and individuals may not be comfortable with virtual communication. Program directors will need to decide if they are willing to take a risk on an applicant they have only met virtually. Many of the in‐person social events may be limited. Evaluation of cities and local neighborhoods may require separate trips. Contrarily, the implementation of virtual interviewing is inclusive of all applicants. Candidates may no longer be restricted to interview at a limited number of programs due to finances or scheduling limitations. The concept of the “interview day” is no longer valid. Virtual platforms may allow for innovative changes that mitigate scheduling limitations previously faced by applicants with the implementation of pre‐recorded tours or presentations and interviews over multiple days. Eliminating the need to travel to traditional interviews may also allow students to complete more clinical experiences at their dental schools within the interview time period. This may be an important factor in fulfilling clinical requirements set by CODA and dental schools. As interviews transition to virtual platforms, residencies must consider other methods of evaluation. Upon selection for an interview, applicants may submit a brief standardized video. This would provide an opportunity to expand upon an aspect of their application or life experience. A video submission may allow for a more personal form of expression without the pressure of an interview. Supplementary questions asked in the application or distributed personality tests may also offer additional evaluation. If externships are restricted to home programs, a dialogue between program directors, faculty, and residents at the home dental school may act as another method to evaluate an applicant's personality. These suggestions would allow the program to gain a better understanding of candidates virtually, replicating the benefit of in‐person interview and externship conversations. The COVID‐19 pandemic provides an opportunity to proactively reevaluate the traditional dental residency application cycle. While the CPA concluded that application deadlines be extended for medical residencies, 1 the timeline for dental residency applications remains unmodified. As such, OMS candidates are subjected to varying levels of uncertainty. With program deadlines approaching, residencies are in a position to impact the trajectory of the next class of residents. We suggest that universal modifications be made regarding OMS application timelines, externships, and interviews. Swift adaptation and official correspondence regarding this pandemic will ensure a successful application cycle, cultivating continued success within OMS residency programs in the setting of COVID‐19–related precautions.