Based on considerations of equity, financial impact, time, and workforce resources, fellowship interviews should, ideally, be conducted in a virtual format. Though uniformity of approach is important for equity among applicants and programs, each subspecialty and fellowship program is distinct. AAIM defers to each subspecialty society to recommend the interview format suitable for their community.  AAIM maintains its position that, to create a level playing field, fellowship programs should strongly consider conducting virtual interviews.

Advances in video conferencing technology and widespread familiarity with these platforms support the use of virtual interviewing. Virtual interviewing offers a standardized format for both applicants and programs. The efficiency offered by virtual interviews saves time for applicants, minimizing time away from their clinical training as well as greater flexibility in interview scheduling. Further, all‐virtual interviews reduce financial costs associated with the interview process for both applicants and programs.² Data from all‐virtual GME interview experiences suggest that virtual interviews are widely acceptable to applicants, as well as fellowship program directors, and allows them to adequately learn about candidates and programs, respectively.^3-6

Fellowship programs should consider offering scheduling options to accommodate applicants in different time zones; institutions should offer applicants access to an appropriate interview setting, as well as reliable internet access.

The Association of American Medical Colleges (AAMC) developed resources to aid applicants and educators navigate and prepare for virtual interviews. Applicants are encouraged to visit the AAMC Virtual Interviews: Applicant Preparation Guide.⁷

Below are key takeaways:

• Gather information about the interview
• Identify sample experiences
• Identify a suitable environment and technology
• Practice describing your experiences
• Practice with technology
• Use clinical and non-clinical experiences in your responses

Optional in-person visits as part of the interview process can serve as a means for applicants to best evaluate their options when selecting a program, as an institution’s customs and a city’s culture will help learners determine their fit and ability to thrive. Further, program-sponsored second looks are a tool for institutions in smaller cities to showcase both their educational offerings and their town’s aesthetics.

AAIM encourages fellowship programs to employ a voluntary rank order list (ROL) lock process, which will allow programs the option of securing their ROL and then allowing interviewed applicants to visit the program, confident in the knowledge that visiting (or not) will not impact their ranking on the list.  Separation of program and applicant ROL deadlines will permit time for applicants to participate in optional in-person second look visits (during the gap period between those due dates) without fear of added bias, since the applicant’s visit would not influence a program’s rank order list.

AAIM strongly recommends that fellowship programs commit to their GME office to submit their rank lists before holding any in-person second looks. To that end, the ideal would be that programs who choose to offer open houses or second looks structure them so that applicants meet with current fellows or other faculty who were not involved in developing their program's rank list. This would set applicants' minds at ease, as well as expose them to other faculty and staff who can provide additional perspective about the program.

Fellowship programs should adopt clear standards for communicating interview standings with their applicants, including anticipated dates and times of when this communication will occur. These processes should be relayed transparently to applicants and made publicly available on a program’s website. Implementing these standards and setting clear expectations will decrease unnecessary stress for applicants and likely decrease communication burdens on programs.

Beginning with the 2025 ERAS recruitment season, the ERAS Interview Scheduler tool will be discontinued. Fellowship programs are encouraged to use Thalamus Core, a complimentary product within the Thalamus suite that serves as an interview management tool with direct ERAS interface. The platform offers interview scheduling functionality and the ability for programs to rank and score interviewed candidates. Further, Thalamus Core includes a functionality that would assist fellowship programs communicate an applicant’s interview status.

Standardized letters of recommendation improve a reviewer’s ability to meaningfully compare applicants and are more efficient for writers and reviewers alike. In 2017, AAIM published guidelines on standardized fellowship letters of recommendation.⁸  These guidelines allow residency program directors to advocate for their learners while providing a competency‐based assessment and description of the residency training experience.

The AAIM Fellowship Letter of Recommendation (LoR) Guidelines have improved the educational handover from residency to fellowship. When compared to letters that did not adhere to these guidelines, fellowship program directors found these conforming letters to be more helpful in many areas. The guidelines provide structure to help overcome challenges involving variation in terminology, length, interpretation, and meaningful comparison. Residency programs are encouraged to fully adopt the guidelines for internal medicine subspecialty fellowship applicants.

In fall 2022, AAIM released recommendations on how to integrate equity into the residency interview process.⁹ These recommendations can be readily adapted for the fellowship interview process. Because implementation will be challenging for any program, the recommendations provide a roadmap on how to prioritize strategies. AAIM recommends that fellowship programs first conduct a needs assessment to determine which recommendations are easily or immediately implementable, then decide which ones could be adopted in the future.

Residency programs should provide residents (i.e., rising fellows) with resources to help them prepare for and participate in virtual interviews.¹⁰ These resources should include preparation education, reasonable time away from clinical duties, and technical support. Specifically, residency programs should work with their GME offices and institutions to provide residents access to a private and appropriate interview location, as well as technology with video conferencing capabilities and reliable internet access. Institutional provision of these resources mitigates the potential for technology bias that may exist when applicants have different technology or financial resources.

AAMC developed resources to aid applicants and educators navigate and prepare for virtual interviews. Applicants are encouraged to visit the AAMC Virtual Interviews: Applicant Preparation Guide.⁷  Below are key takeaways:

• Gather information about the interview
• Identify sample experiences
• Identify a suitable environment and technology
• Practice describing your experiences
• Practice with technology
• Use clinical and non-clinical experiences in your responses

Problematic communications have been reported during GME interviews. Without appropriate training, faculty interviewers may inadvertently violate match agreements by inquiring into topics such as rank order lists, interview locations, or geographic preferences. Additionally, post‐interview communication has the potential to create confusion and stress for applicants, particularly when coercive or disingenuous.

With more than a dozen Internal Medicine subspecialties and each aptly represented and supported by their respective society or organization, AAIM defers to each subspecialty society to develop post-interview communication recommendations or guidelines that best reflect their community’s values and needs. As the various subspecialty societies develop and socialize their respective post-interview guidelines or recommendations, AAIM encourages subspecialty organizations to include language that prohibit programs from sending tailored, individualized post-interview communication outside of the parameters set forth below.  

• Programs who wish to send updates or any program-initiated informational outreach or post-interview events should share these with all candidates, regardless of their background, standing, or track interest. An exception would be communication to a specific group – as an example, candidates applying to a program’s physician-scientist or research-in-residency track.  
• Programs should articulate that interviewees refrain from sending “thank you” notes.  Rather, programs should state that applicants are welcome to ask clarifying questions about the program. Fellowship programs can also indicate that they are willing to share additional information pertaining to their program at the candidate’s request. Faculty and staff should emphasize that they are prohibited from communicating the candidate’s odds of ranking or matching to their program.  

Adherence to the NRMP Match Code of Conduct for Programs (PDF) concerning post-interview communication is critical:

Program directors and other recruitment team members must ensure all information related to the program’s mission, aims and eligibility are clearly communicated to applicants. However, applicants may not have adequate time to obtain the information needed to make informed decisions about ranking and may wish to clarify information following interviews. The recruitment team may exchange clarifying information with applicants following the interview, but must not solicit or require post-interview communication for the purposes of influencing applicants’ ranking preferences. Program directors and all members of the recruitment team should take great care not to promote misleading communication to applicants about ranking intentions and preferences or inappropriately share private information (e.g., letters of recommendation) with outside parties.

Fellowship programs should require annual faculty and staff training on appropriate interview and post‐interview communication to minimize inappropriate dialogue.¹¹ Below are a few suggestions on what should be covered in the training:

• Describe the range of benefits of adherence for the program and individuals
• Articulate the range of negative consequences of non-adherence for programs and individuals; if possible, provide data on occurrence and examples of inappropriate communication
• Provide samples of appropriate questions. It is advisable to conduct role-playing or scenario-based instruction
• Review practices to mitigate differences in communication based on explicit and implicit biases

Resources and training materials are available on the AAIM website. The Annual Training for Fellowship Recruitment Communication presentation can be customized based on a program’s needs and resources. All program representatives involved in interview-related activities must participate in annual training and complete an attestation form.

Further, residency programs should share resources with applicants (i.e., rising fellows) on how to respond to inappropriate communication should it occur. Faculty involved in interviewing applicants should receive training on unconscious bias that may arise during the interview process.¹²

Overall, programs should develop a succinct statement about their program’s policies on communication with applicants. This statement should clearly indicate the following:

• Adherence to the NRMP Match Agreement and Code of Conduct
• Indicate that annual training does take place
• Share where applicants can find a program’s policies