Sunday, January 14, 2018

Applications and interviews for medical residencies

The computerized clearinghouse for the NRMP medical match solves the congestion problem for new doctors when it comes time to make offers, acceptances and rejections. But electronic applications make it easier to apply for lots of places, and this is coming to seem like a problem in both the resident match and in the later-career fellowship matches.

Residency Placement Fever: Is It Time for a Reevaluation?
Gruppuso, Philip A. MD; Adashi, Eli Y. MD, MS
Academic Medicine
Issue: Volume 92(7), July 2017, p 923–926

Abstract: The transition from undergraduate medical education to graduate medical education (GME) involves a process rooted in the final year of medical school. Students file applications through the Electronic Residency Application Service platform, interview with residency training (i.e., GME) programs from which they have received invitations, and generate a rank-ordered preference list. The National Resident Matching Program reconciles applicant and program rank lists with an eye towards matching students and GME programs. This process has effectively served generations of graduating medical students. However, the past several decades have seen an intensification of the residency placement process that is exemplified by an inexorable increase in the number of applications filed and number of interviews accepted and attended by each student. The authors contend that this trend has untoward effects on both applicants and departments that are home to GME programs. Relevant information in the peer-reviewed literature on the consequences and benefits of the intensification of the residency placement process is scant. The authors address factors that may contribute to the intensity of the residency placement process and the relative paucity of data. They propose approaches to reverse current trends, and conclude that any reevaluation of the process will have to include the generation of outcome data to afford medical educators the opportunity to explore changes in an evidence-based manner.

"In part, the intensification phenomenon is borne out by the aforementioned growth in ERAS-associated traffic. In the eyes of many, this “new normal” draws on the widespread perception that a successful match in highly competitive disciplines is contingent on the filing of applications with a large proportion of the relevant GME programs. For example, in 2015, senior U.S. medical students applied, on average, to 73 of the 163 orthopedic surgery programs and 47 of the 105 neurological surgery programs (based on data extracted from the AAMC 8 and the NRMP 9,10). What is more surprising is that even less competitive disciplines may now be seeing an ever-growing flood of applications. This contention is supported in part by recent observations according to which GME programs in nearly all disciplines have seen a marked increase in their application traffic. For example, the percentage of pediatric GME programs to which graduating U.S. medical students have applied on average increased from 9.8% to 13.7% during the five-year interval from 2010 to 2015.10 For internal medicine GME programs, the corresponding figures are 4.9% to 6.0%.8–10 In making these decisions, students appear to be keeping their own counsel against the advice of medical school advisers and mentors advocating moderation."
"First, consideration should be given to the possibility of coordinating the timing of the interviews and of the Match across all disciplines and GME programs, including the “early match” disciplines of ophthalmology and plastic surgery.32 Consolidation along these lines would address the disruption of fourth-year scheduling, thereby offering educators greater flexibility in designing the fourth-year curriculum. Implementing such changes will not be easy given the longevity, familiarity, and comfort associated with the extant construct. Voluntary action on the part of the relevant professional associations will be required should a realignment of current schedules ever come to pass. Second, reducing if not capping the number of interviews per student would go a long way towards stemming the time and resource drain on both applicants and GME programs. This, too, is not going to be easy given the near-universal presumption that “more is better” and the notion that the times in effect demand such. In this context, consideration might be given to a tiered “screen and schedule” system wherein initial online interviews with many or all eligible applicants would be followed by a limited set of on-site interviews with a select group of “finalists.” As envisioned, this approach, widely used in both the public and the private sectors, stands to rationalize the current residency placement process while maintaining its fundamental premises of excellence and compatibility. Limiting the final on-site interviews to a select number of candidates will also give rise to palpable economies of scale that are likely to be welcomed by applicants, GME programs, and medical schools alike."

1 comment:

Kathryn said...

This is very informative post. Thank you for sharing this.