In “The Residency Match: Interview Experiences, Postinterview Communication, and Associated Distress,” Berriochoa et al1 discuss the current landscape of postinterview communication with a focus on the applicant perspective. This article adds to the body of literature suggesting that postinterview communication may be a significant source of stress for applicants.2–4
In our roles in student affairs, we see firsthand the daily stress students experience trying to meet the expectations of their potential future program. We hypothesize that this dissonance is significantly exacerbated by generational differences in responding to unclear expectations. Eighty percent of graduates responding to the 2017 American Association of Medical Colleges Graduation Questionnaire are born of the millennial generation.5 In contrast, program leadership and faculty more likely view the interview process through different generational lenses. In several fields, the average age for program directors is mid-40s.6,7
We know there are generational differences surrounding expectations about and reactions to relationships.8 Waljee et al8 summarized these differences and discussed how they affect mentoring in medicine. These differences likely also affect the program director–potential trainee dyad represented in the match interview process.
Applicants who are members of the millennial generation theoretically should be primed toward positive perceptions of postinterview communication. Raised in an era of instant communication, and accustomed to frequent short meetings to communicate expectations, they tend to favor flat, nonhierarchical structures and expect rapid responses. Motivated by purpose, they may rely on an ongoing relationship with the program director to inform their opinion of personal “fit” in the program. With applicants applying to more programs than ever,9 we can postulate that they willingly aim to meet the given program's expectations that increase their competitiveness. The reported stress of postinterview communication thus could be related to unclear rules of engagement. Millennials are dutiful and rule conscious.10 Even if a program director states postinterview communication is unnecessary and actively discourages it, millennials still may worry that they should engage in it, based on the fear that other applicants may be doing it. In the age of social media, the “fear of missing out” often is amplified, and this may contribute to explaining Berriochoa and colleagues' finding that 91% of applicants did engage in postinterview communication.
Millennial applicants likely are contacting baby boomer and generation X program directors. Baby boomers typically feel that direct communication subverts conventional hierarchies and workflow. During the time-pressed residency application season, these program directors may feel time pressures, and they might unfairly typecast millennial applicants as “needy.” This unconsciously sets up an adversarial relationship and may subvert the very relationship millennials are trying to cultivate with their outreach.
Generation X representation among program directors is on the rise. Members of this generation tend to favor direct communication; they may reject authority and mistrust rules. Therefore, they have more in common with millennials in their communication style. However, unlike millennials, they tend to use e-mail as their preferred communication strategy and keep communication bound within work hours. In that context, postinterview communication may be viewed as additional work, and they may not appreciate its relationship-forming aspect—particularly during the busy application season.
Thank you notes are a specific subset of post-interview communication that deserves comment. Baby boomers may not even view thank you notes as an example of postinterview communication but rather as a standard extension of an interview. Millennials may have been raised with this construct by their baby boomer parents. Some specialty-specific sources of advice for applicants continue to recommend thank you notes.11,12 However, this strategy can result in a significant workload for applicants, who typically interview with many faculty and residents at a given program. Regardless of whether postinterview communication takes the form of other thank-you notes or other formats, engaging in this activity can be a significant distractor for senior medical students, whose time could be better spent in critical educational and residency preparation tasks.13
It is heartening that the medical education community is examining this issue. Some programs tell applicants that they will not engage in postinterview communication. The 2014 Association of Program Directors in Internal Medicine (APDIM) Statement on Post-Interview Communication & Second Visits recommends that this should be adopted by every internal medicine program.14 Three years after the APDIM guideline release, the rate of programs engaging in postinterview communication has dropped only 7%, despite a majority of program directors stating that postinterview communication has no effect on their rank list. In line with baby boomer era norms, program directors mentioned good manners and applicant expectations as their top reasons for continuing postinterview communication.15 While 71% of applicants in the Berriochoa et al1 study would feel relieved if postinterview communication were actively discouraged, we do not know whether they would still engage in this activity, or whether programs discouraging postinterview communication would actually reduce applicant stress. Some question whether the National Resident Matching Program (NRMP) should play an expanded role in providing clear and binding guidance on postinterview communication.2 In our opinion, this would be a step in the right direction, as students are mindful of the NRMP as a powerful policymaker, but they are less likely to be aware of their individual specialty society recommendations.
Regardless of generation, human nature craves certainty. Creating explicit rules for postinterview communication, or actively discouraging or eliminating it altogether, offers the potential for time savings and decreased stress on applicants and program directors—a win for baby boomers, members of generation X, and millennials.