Abstract
Objective. To assess the impact of the COVID-19 pandemic on pharmacy residency application/interview processes, match rate, and factors influencing match rankings at a single college of pharmacy
Methods. In spring of 2020 and 2021, an anonymous survey of fourth-year pharmacy school (P4) residency applicants at one college of pharmacy was administered. Survey responses were compared to explore trends in showcase participation, number/type/geographic dispersion of applications submitted, interview invitations, grade point average (GPA), research experience, and match rate. A thematic analysis evaluated common factors influencing match rankings.
Results. Responses were collected from 75 of 99 (75.8% response rate) residency-seeking students in 2020 and 79 of 94 (84.0% response rate) in 2021. Students in 2021 reported applying to a higher median number of programs, with no significant differences in mean reported number of interview invitations or match rate. The virtual American Society of Health-System Pharmacists (ASHP) Midyear Showcase led to a median reported savings of $1000 with no significant impact on perceived value. Virtual interviews led to a median reported savings of $430. Thematic analysis revealed feel/culture, location, and learning experience options as the most prevalent deciding factors for match rankings in both years.
Conclusion. The pandemic led to an increase in the number of residency applications per student and yielded a net cost savings. There were no differences in number of interviews offered, match rate, or in deciding factors influencing match rankings. As the pandemic evolves, schools should maintain a flexible and dynamic approach to support students.
INTRODUCTION
The pharmacy residency application and interview process is extremely competitive. Over the past decade, growth in the number of pharmacy schools and intensified interest in residency training has led to an increase in residency applicants. This increased number of applicants continues to outpace the number of available residency positions. In 2021, the American Society of Health-System Pharmacists (ASHP) Resident Matching Program had 7595 postgraduate year one (PGY1) applicants for 4042 PGY1 positions.1 In the 2020-2021 application cycle, the COVID-19 pandemic necessitated transitioning to virtual residency showcases for the ASHP, American College of Clinical Pharmacy, and various regional and state organizations. In-person residency interviews were strongly discouraged by ASHP and its Accreditation Services Office; thus, a majority of programs transitioned to virtual interviews.2
The pandemic has led to significant changes throughout health care systems and has posed new challenges for pharmacy trainees nationwide. Multiple studies have characterized pharmacy resident and fellow experiences during the pandemic, but data have not yet been published exploring the impact on pharmacy students pursuing residency training.3,4 Shreffler and colleagues provided an early characterization of the perspectives of medical residency applicants in a virtual interview process, finding that applicants were concerned about the ability to fully assess programs or fully demonstrate their personalities virtually.5 Others have identified potential benefits to virtual interviews for medical students, including decreased costs for applicants, minimized time away from rotations, and increased flexibility for interview dates and times.6-8 Additionally, virtual interviews may promote equity and diversity by removing application barriers sometimes encountered by marginalized groups.8
Over the last five years, an average of 91 (65%) of the approximately 140 annual graduates at the University of Kentucky College of Pharmacy (UKCOP) applied to PGY1 residency programs with approximately half of the graduating class entering residency training each year. According to the American Association of Colleges of Pharmacy 2021 Graduating Student Survey, approximately 33.5% of respondents reported intentions to participate in residency training after graduation.9 Given the large proportion of the graduating cohort at UKCOP pursuing residency training, our survey data could provide valuable insight into the pandemic’s impact on the residency application and interview process and may have broad applicability for curricular and cocurricular programmatic changes. The objectives of this study were twofold: first, to assess the impact of the COVID-19 pandemic on the pharmacy residency application/interview process and match rate and, second, to analyze, using thematic analysis, the impact of the pandemic on deciding factors influencing match rankings.
METHODS
In the spring of 2020 and 2021, we conducted an anonymous survey of UKCOP fourth-year pharmacy school (P4) students who had applied to residency programs. The survey was pretested by faculty and staff in the office of student affairs. Surveys were disseminated to students via email and administered via REDCap, a secure, encrypted online database,10 during the week prior to Phase I Pharmacy Match Day in 2020 and in 2021. The survey instrument consisted of 31 items in 2020 and 32 items in 2021. The 2020 survey occurred following an entirely pre-pandemic residency recruitment cycle, while the 2021 survey was conducted amid the virtual recruitment cycle necessitated by the COVID-19 pandemic. As such, several of the 2021 survey items were customized to collect specific information regarding virtual residency showcases and interviews. Demographic information included self-reported grade point average (GPA) and participation in a research project, poster presentation, and/or publication. Both surveys included items exploring trends in residency preparation including mentorship and participation in state, regional, or national residency showcases. Application questions included number of applications submitted, types of programs, and geographic area to which they applied (ie, local programs, programs within the state, programs in a specific region of the country, or programs at various locations throughout the country). Interview items included the number/type of interview invitations and estimated costs associated with the residency pursuit process. The study was approved by the institutional review board at the University of Kentucky.
Descriptive statistics were used to characterize 2020 and 2021 survey responses. The following items were compared: GPA, research experience, participation in the ASHP Midyear Residency Showcase, estimated cost of attending ASHP Midyear Residency Showcase, perceived value of showcase participation on applicant’s program selection process, number of residency applications submitted, type of residency programs to which applicants applied, geographic area to which applicants applied, number of interview invitations, and interview expenses. Categorical variables were analyzed using the Pearson chi-square or Fisher exact test as appropriate. Continuous variables were analyzed using independent samples t tests or independent samples differences of medians as appropriate. Variables meeting parametric assumptions are reported with means and standard deviations, while variables not meeting parametric assumptions are reported with medians and interquartile ranges. In the 2021 survey, ASHP Midyear Showcase expenses were assumed to be $0, consistent with ASHP’s 2020 Midyear Student Registration cost of $0 and no travel required due to the virtual format. As a subgroup analysis, we compared three categories of GPA (<3.5, 3.5-3.74, and 3.75-4.0) to number of interview invitations for the entire cohort of respondents and for the 2020 and 2021 data sets using a one-way analysis of variance (ANOVA) with a pairwise post hoc comparison using a Bonferroni correction. Statistical analysis was completed with SPSS Statistics version 27 (IBM Corp).
We conducted a thematic analysis for the open-response question “What was the deciding factor for the residency program you ranked number one?” Two coauthors read and reread the responses to identify emergent themes. After the major themes were determined, the coauthors independently coded the responses, then discussed each response to reconcile differences.11 A third coauthor was designated to resolve any disputed items. Factors contributing to residency program rankings were then compared for 2020 and 2021.
RESULTS
Survey responses were received from 75 of 99 and 79 of 94 students applying for residency, yielding response rates of 75.8% and 84.0% in 2020 and 2021, respectively. As shown in Table 1, GPA was comparable between the class of 2020 and class of 2021, with more than 70% reporting a GPA greater than 3.5 each year (p=.1). The average GPA for the class of 2020 and 2021, respectively, was 3.54 and 3.59. Likewise, no significant differences were found between cohorts regarding research experience, with more than 90% of students reporting research experience each year (p=.7). The median number of reported applications submitted in 2020 was nine (IQR 4.0, 7.0-11.0) compared to a median of 11 (IQR 4.0, 8.0-12.0) in 2021 (p<.001). There were no reported differences in number of interview invitations, with a mean (SD) of 5.6 (3.01) in 2020 compared to a mean (SD) of 5.9 (3.61) in 2021 (p=.5). Additionally, the UKCOP residency match rate was similar across both years, with 74.7% matching in 2020 and 80.3% matching in 2021 (p=.6).
Comparison of Residency Applicant Characteristics Before and After Onset of the COVID-19 Pandemic
Greater than 69% of students across both years reported participating in the ASHP Midyear Residency Showcase. In the 2020 survey, the median reported expense to attend the Midyear Showcase was $1,000 ($700-$1,200) compared to $0 ($0-$0) in 2021 (p<.001). No significant differences were noted in the perceived value of showcase participation in assisting with residency program selection between years. Reported interview expenses varied significantly across years, with a mean (SD) 2020 expense (excluding application costs) of $430 ($100-$1000) compared to $0 ($0-$20) in 2021 (p<.001).
As shown in Table 2, students participating in the pandemic-impacted residency interview process in 2021 cited high levels of perceived preparedness for the virtual interview experience (94.6%). Most students reported conducting virtual interviews from their home (90.5%), followed by from the college of pharmacy or library (24.3%), and only one student reported conducting an interview from their advanced pharmacy practice experience site (1.4%).
COVID-19 Pandemic-Impacted Interview Trends for 2021 (n=79)
Thematic analysis yielded no disputed items. Several common themes emerged among deciding factors influencing applicants’ program ranking, including feel/culture, location, and learning experience options (Figure 1). No significant differences in deciding factors were found between 2020 and 2021.
Deciding factors influencing pharmacy students’ match rankings for residency programs by year.
DISCUSSION
Results of this study help describe the pandemic’s impact on pharmacy residency application, interview, and selection processes at a college of pharmacy with more than half of students pursuing residency training. The pandemic-impacted class of 2021 students reported applying to more residency programs, reported yielding the same number of interviews offered, and resulted in no change to the college’s overall match rate as compared to the class of 2020 students. Students incurred fewer expenses participating in a virtual showcase environment without any change in perceived value compared to that reported by students who attended in-person showcase formats the year prior. Similarly, students reported spending less on interview expenses. Deciding factors for ranking residency programs remained consistent across the two student cohorts surveyed in this study. These data may help residency programs and colleges of pharmacy better understand the student perspective of the pandemic’s impact on pharmacy residency pursuit. As virtual recruitment components are predicted to continue selectively in the future,12 these data provide valuable insight to assist residency and pharmacy programs. Flexibility will be essential, as strategies for virtual recruitment and student success programming may need continuous reassessment and optimization in an ever-changing environment.
The 2021 cohort reported applying to a median of 11 residency programs, whereas the 2020 cohort reported applying to a median of nine residency programs. Although the number of applications in 2021 was significantly higher than in 2020, the 2021 number appears to align with the historical national average of applications per student. The most recent national data on the average number of program applications per student was published in 2019, with 8066 applicants applying to a total of 88,375 programs for an average of 11 applications per student.13
Both 2020 and 2021 cohorts of students ascribed similar value to showcases across years; however, it is well documented that applicants need a different skill set to succeed in virtual versus in-person recruitment settings.6,12,14 As such, colleges and schools of pharmacy must ensure students are adequately prepared to successfully interact in both environments. Curricular and cocurricular programming will likely need to be modified to include information on in-person and virtual showcase formats and appropriate professional etiquette in the virtual setting. In this study 69% and 79% of students participated in the ASHP Midyear Showcase. While participation was lower than anticipated, published data on showcase participation among residency applicants are lacking. Costs for showcases and interviews were understandably lower in 2021. However, the mean reported interview cost of $430 in 2020 seems exceptionally low considering the geographic dispersion of applications submitted.
Our study has several limitations to consider. Surveys were administered for programmatic quality improvement purposes in pre-pandemic and pandemic-impacted timeframes, resulting in minor year-over-year differences in several survey items. For example, interview expenses were collected categorically in 2020 and as a free text item in 2021, making it difficult to parse whether 2021 students had included application expenses along with interview costs. Since survey items, such as GPA and research participation were self-reported, we cannot rule out the possibility of overinflation of these items due to social desirability response bias. Nonresponse bias may have also influenced our results, especially among students who believed their chances of matching were low. Additionally, due to the relatively small sample size, our study carries a risk of type II error. In the thematic analysis evaluating deciding factors influencing match rankings, several factors were noticeably different, but small sample size among less-cited factors may have impacted the ability to demonstrate significance. Generalizability may also be limited due to school differences in geographic location, demographics, or residency participation rates.
CONCLUSION
The pandemic led to an increase in the number of residency applications per student and yielded a net cost savings. Students from the pandemic-impacted class reported receiving a similar number of interview invitations, with no difference in overall college match rates or in deciding factors influencing match rankings. As the pandemic continues to evolve, a flexible and dynamic approach to curricular and cocurricular programming will be essential for success.
ACKNOWLEDGEMENTS
Use of the REDCap online survey database was supported by the National Institutes of Health National Center for Advancing Translational Sciences through a grant.
- Received November 8, 2021.
- Accepted March 24, 2022.
- © 2023 American Association of Colleges of Pharmacy
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