Monday, September 24, 2018

Are there too many interviews for medical residencies and fellowships? Should there be an interview Match?

A recent article in JAMA considers the question in the title of this post:

September 21, 2018
Matching for Fellowship Interviews
Marc L. Melcher, MD, PhD; Itai Ashlagi, PhD; Irene Wapnir, MD

"Most surgical training programs interview many candidates because the consequences of not matching harms the reputation of the program and affects the work force of their services.5 Surveys of pediatric surgery program directors in 2011, 2012, and 2014 revealed that they interviewed a median of 24 to 30 candidates per year. However, the median rank at which the programs matched was less than 4, and programs never matched beyond their 12th choice, suggesting that they did not need to interview as many residents as they did.
"instituting an interview match may be one approach to help improve the interview selection process by reducing the large numbers of unfruitful and costly fellowship interviews. For example, Ashlagi et al7 found in a theoretical matching model that when candidates and programs each have highly heterogeneous preferences, limiting the number of interviews improved the efficiency of the matching process. Thus, fellowship interview matches represent an opportunity to reduce the excessive number of interviews and optimize the selection of applicants.

"A practical strategy that may achieve this goal is an interview match that precedes the existing match. After applications are submitted, candidates and programs submit rank lists that could be used to fill limited interview slots. Mechanisms that enable applicants and training programs to signal interest in each other have been proposed.4,7 By ranking candidates and programs highly, both essentially are respectively signaling their strong preference for each other.4 Therefore, fewer interviews might be sufficient for candidates and programs to identify mutually desirable matches and reduce the number and costs of interviews. If the program and candidate interview slots remain unfilled, a secondary match could be performed to fill unmatched interview slots.
"n conclusion, a well-designed interview match may help reduce excessive costly interviews while more efficiently pairing candidates and programs, so that both achieve as many highly ranked choices as possible. This strategy could be applied broadly to matching programs in other medical specialties and may be attractive at earlier career stages such as residency interviews."

And here's a related news story on the Stanford Medical School site:

The current fellowship interview process is cumbersome — Stanford researchers have a better idea

"In their fourth and fifth years, surgical residents are busy: They're caring for patients, assisting junior trainees and fulfilling their own training requirements. And that's not all: About 75 percent of these residents are scrambling to squeeze in interviews for fellowships across the country, often packing in between 6 and 15 interviews to ensure they secure a spot, Stanford transplant surgeon Marc Melcher, MD, PhD, told me.

"Fellowship program directors, including Stanford surgeon Irene Wapnir, MD, who directs the breast surgical fellowship, are similarly harried. To fill typically one position, the directors can interview 20 or more doctors to find a quality candidate whose interests match their program.
"The process is also expensive and time-consuming. When experienced residents leave, their coworkers need to cover for them, and the residents must pay their own way to travel to interviews, Melcher said.
"Melcher and Wapnir reached out to their Stanford Engineering colleague Itai Ashlagi, PhD, who specializes in the design and analysis of marketplaces, such as matching kidney donors with recipients.  Together with Alvin Roth, PhD, a Stanford economist, they're proposing a new fellowship interview matching system. Their concept appears in JAMA.
"The researchers propose two key changes. First, applicants and programs would signal their preferences for each other — before making travel arrangements and setting aside days of valuable physician time. In addition, the number of interviews for each fellowship program would be capped, as would the number of interviews for each candidate, Melcher said."

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