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You May Turn Off Your Cameras Now: Trials & Tribulations of the Cardiology Fellowship Zoom Interview Trail

Last month, I dedicated my blog post to tips for prospective Cardiology fellowship applicants. In this companion piece, I would like to share my experience on the Cardiology fellowship virtual interview trail. Part of my motivation is to provide additional information for Cardiology fellowship applicants, but also to shed light on various approaches – both successful and unsuccessful – to the virtual interviews. There was much hand-wringing this past year about the diminishment of the fellowship interview experience, which by necessity became all-virtual due to the COVID-19 pandemic. In some ways, it was better – the lack of travel made it more affordable and increased flexibility. In other ways, it was worse – being on camera for seemingly endless hours and feeling as if programs were invading your private space at home. Here are some takeaways from the 2020 Cardiology fellowship virtual interview season.

Virtual interviews are convenient

Say what you want about virtual interviews, but there is no denying that they are more affordable, convenient and flexible. Residents working 60-80 hours a week suddenly did not have to spend thousands of dollars traveling around the country. Applicants did not have to leave the comfort of their own home or office to interview around the country and as a result did not have to work as hard to find extra coverage. These decreased barriers democratized the interview process. However, virtual interviews also encouraged applicants to apply to more programs, clogging up the application pile and making it harder for fellowship program directors select among many highly qualified applicants.

Virtual interviews are surprisingly exhausting

Although Zoom interviews were convenient, many applicants found them to be mentally and emotionally draining. No matter how hard you try, Zoom cannot replace a real-life social interaction that is influenced not just by the things that you say or your facial expressions, but by the environment around you and the participants’ body language. Much of this context is lost during a video interview. Instead you are left with the feeling that you must be “on” all the time, lest the person on the other side of the camera misperceive you as being uninterested. That is not to say that you are not being closely observed at an in-person interview, but that this feeling of being under the eye is heightened when you are staring at a blinking green camera dot on your laptop for hours on end. As a result, the overall experience ended up being more tiring than I anticipated.

We could all stand to spend less time on camera

Although I have always thought of myself as an extroverted person, I found it difficult to be on camera for more than a couple of hours at a time. In fact, I greatly appreciated when program directors or coordinators took care to encourage us to take a break and turn off our cameras during gaps in between interviews. During these breaks, I would get up, stretch, and in a few cases even left my apartment to go for a short walk around my neighborhood.

A virtual interview does not need to last an entire day

I grew to appreciate efficiency and brevity in a virtual interview day. One interview day lasted for nine hours. By the eighth hour, I felt exhausted and unable to retain any further information. I had heard what I needed to hear about the program; those last few hours did not augment my experience. The most memorable part of the day ended up being the relief I felt when I logged off as the sun was setting. That overall experience would have been more pleasant, and the same amount of information would still have been conveyed, if the day had ended a few hours earlier. Therefore, I would argue that the ideal interview day length is four to five hours: a program should be able to conduct interviews and transmit all key information to applicants in, at most, six hours.

It’s hard to get the “pre-interview dinner” right on Zoom

Some programs chose to host a pre-interview Zoom “dinner” the night(s) before the interview, while others did not. Looking back on it, this decision did not affect how I viewed individual programs. I found one-on-one conversations in which I could talk with current fellows, especially fellows with whom I had some kind of personal connection, to be much more helpful than stilted virtual “dinners.” The experience with these Zoom “dinners” was variable. Some were well-run, leaving little ambiguity about what we were supposed to do at any given time and controlling the pace of conversations in a way that avoided awkward pauses. Others were disorganized to the point of being uncomfortable to sit through. These sessions are challenging because while some people prefer to be very active participants, others wish to more passively observe and take in information. It is difficult to cater to both of these types of people in a way that feels natural.

My recommendation: if you are going to host a Zoom, the session should be heavily structured so that 1) participants know exactly what to do at any given time, 2) applicants are given the space to ask questions without having to compete with others (short, timed breakout room sessions help with this), 3) providing discussion topics to fellows in case a group of applicants is unusually quiet and 4) ending sessions in a timely fashion so that participants do not have to sit in excruciating silence when everyone has run out of things to discuss. Efficiency is your friend here, as well.

You CAN still get a “feel” for a place without physically being there

Program directors and applicants were concerned that we would not get a good “feel” for individual programs without physically being there. I found conversations with fellows and attendings at various programs to be incredibly helpful in filling this gap. To my own surprise, by the end of most interview days, I logged off feeling as though I had a pretty good sense of what each program valued and ways and whether it might be a good fit for me.

Virtual interviews should be an opportunity to re-think how we do interviews

Instead of perceiving it as a crutch, program directors should view the virtual aspect as a chance to revitalize the interview day and distill it to its essentials. In some interviews, it felt as though programs were trying to recreate the entire in-person interview day on Zoom. This is a flawed approach because not everything translates well to Zoom. For example, pre-produced videos about the program do not need to be played in real-time during the interview day – applicants can watch these on their own time. Likewise, some PowerPoint presentations could also be pre-recorded for applicants to view in advance. The end result would be a leaner, more efficient interview day in which the limited on-camera time is spent interacting with others, so that applicants come away with a more nuanced and comprehensive understanding of each program without spending an entire business day on camera.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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A Resident in a Virtual Sea of Cardiology: My #AHA20 experience

As a current Internal Medicine resident and one of the youngest members of this year’s class of AHA Early Career Bloggers, my #AHA20 experience was equal parts thrilling, educational, and overwhelming. This was my first time attending the AHA Scientific Sessions and my second virtual conference experience after this year’s QCOR 2020 Scientific Sessions.

On a personal level, although it was convenient to virtually attend from my couch or work rather than fly across the country, I found it challenging to balance my time attending the conference with my clinical work: I was rotating on the Medical ICU at the time and was on call at times during the conference. Nevertheless, the more affordable and virtual nature of the conference and the ability to view sessions that I missed on-demand felt more inclusive to me. I also really appreciated the number of sessions dedicated to early-career trainees and attendings.

It was difficult at times to keep up with a large number of sessions or choose from the rich diversity of options, but overall I loved that there was a little something for everyone. I particularly enjoyed sessions about current state of care for heart failure, controversial trials such as OMEMI, STRENGTH and exciting, ingeniously-designed trials like SAMSON, and the big topic of #AHA20, the intersection of COVID-19 and cardiovascular health.

Most strikingly, the fact that the conference was all-virtual allowed for greater democratization of the dissemination of cardiovascular knowledge. In addition to all the wonderful content supplied by the AHA, there existed in parallel an equally comprehensive and all-consuming universe of discussion on Twitter. I found myself partaking in quite a few amazing Tweetorials or Twitter discussions about different topics presented at #AHA20! Any presentation you could think of was further broken down into bite-sized pieces of information by numerous expert cardiologists in the field. You could ask any question, and a leading expert in that area who had also viewed the presentation could answer your question to help you better understand the topic! As a trainee, I thought this made it easier for me to engage with other conference attendees in a medium with which I, as a millennial, am very comfortable. I also thought that the continued reinforcement of takeaways from the conference via my Twitter news feed helped me retain more knowledge than I usually do after I leave a conference. Although there was a deluge of content to wade through, the ability to re-watch sessions or re-read discussions about them made it easier to reinforce my learning.

Attending #AHA20 virtually as a trainee and getting to engage in the incredible online discussions both during and after sessions on Twitter was a very enriching experience for me. The ability to interact online and in real-time with other trainees, fellows, and attendings around the world made me feel as though the whole experience was more equitable, democratic, and accessible to early-career attendees like me. Finally, most of all, it engendered in me an even greater excitement to begin my Cardiology training in July 2021 and to continue conducting research that I can hopefully present at future AHA meetings.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Diversity, Equity, & Inclusion Are Not Just Buzzwords— Practical Steps for People Who Teach

Those of us who work in science, healthcare, and academia often find ourselves teaching others, whether or not we set out to be educators. Residents teach medical students. Nurses precept new nurses. Graduate students teach undergraduates. And faculty roles for researchers and clinicians also include teaching loads. Yet for many of us, our training did not include any grounding in how to teach. We might not have brought the same theoretical rigor and deep expertise to our teaching that we have to our other roles. Now, as we are teaching in a world of rapid change and increased awareness around structural racism, we must approach equity in our educational practices with intention, but some among us may not feel prepared and we are already overwhelmed. We are already adapting to enormous change related to COVID-19, and the intellectual energy required to reexamine another entire part of your professional life can feel paralyzing. It can feel like an impossible task that there will never be time for.

Despite these barriers, I strongly believe that you can start (or carry on) right now, no matter where you or your institution are in the struggle for antiracism. Here are some immediate suggestions to make your practice as an educator explicitly equity-focused and antiracist, for folks who teach in all kinds of contexts (these topics work for self-education, too):

No matter what format you teach in, there are some basic practices you can adopt to establish a “floor” for equity and inclusion.

  • Can you pronounce the name of everyone in your group? Do you know what they prefer to be called and what pronouns they use? Some teachers inadvertently avoid calling on students because they haven’t bothered to learn these things and don’t want to make a mistake. Don’t be that teacher.
  • How much time does every person (including you) speak? Is anyone taking up more space than they need? Now, the era of video calls, some platforms can actually show you how much time each individual speaks for, and this can be eye-opening. I encourage you to actually measure and observe this at least once. It can be surprising to see how some groups are consistently dominating conversation at the expense of others.
  • Have you adopted principles of Universal Design for Learning in your teaching? If not, now is a good time to start. UDL is a set of principles that improves the experience for all learners by focusing on accessibility and flexibility and assuming diversity.
  • Are you yourself familiar with concepts of antiracism? Have you examined your own privilege, bias, and ignorance? Are you learning?

For those who teach in a classroom or seminar format, Dr. Valerie Lewis has shared some more tips:

  • Include an equity-focused reading with every topic (e.g., if you are teaching about asthma, include an article about disparities related to race and social determinants of health).
  • Message that equity isn’t a specialty; every field should address it as part of ongoing professional practice.
  • Create a dedicated class session for equity, and if possible do two— one at the beginning to frame the ideas for learning, and one towards the end to integrate the content you’ve covered with broader ideas around equity. This can help to lay the groundwork for ongoing reflective professional practice.
  • Audit your syllabus: can you include AT LEAST one scholar of color every week? You might have go-to reading lists that you’ve inherited or developed, but if your list doesn’t measure up, you can change it. Go to PubMed or google scholar. Look at professional societies. Ask colleagues. Crowd-source on twitter. This is a key way to amplify voices— remember that citations are academic currency.
  • Don’t be afraid to make mistakes. Be open with students that you are doing this intentionally and why, and take feedback.

This is not a checklist or an exhaustive resource for inclusivity. But I hope that if you are floundering as you try to figure out how to teach with a focus on equity and inclusion, that you’ve got a good first foothold. Let’s keep the conversation going— I’d love to hear more ideas. Hit me up on twitter @TheKnightNurse and let me know what you are doing.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”