Interesting development in the transition from medical school to residency: connecting applications and interviews

 The market for new doctors has been suffering from congestion in applications and interviews, in the runup to the resident Match (see recent post with a diagram). The American Association of Medical Colleges runs the main application server, ERAS. A private company called Thalamus runs a growing interview scheduling service. Now they are looking to collaborate.

 Here's  yesterday's press release from Thalamus:

AAMC, Thalamus Announce New Collaboration to Improve Transition to Residency

April 27, 2023 by Team Thalamus

Collaboration will increase transparency and make the residency process easier for applicants and programs  

Washington, D.C., April 27, 2023—Today the AAMC (Association of American Medical Colleges) and Thalamus announced a strategic collaboration to accelerate innovation and ease the transition to residency for medical students, medical schools, and residency programs. The collaboration will combine the AAMC’s long-established leadership in innovation along the continuum from medical school to residency training and continuing medical education with Thalamus’ market-leading product and software development expertise. 

“The transition from undergraduate medical education to graduate medical education is a critical period in any learner’s journey to becoming a physician,” said David J. Skorton, MD, AAMC president and CEO. “We know the community is seeking enhanced tools and integrated services that better support application and recruitment processes. We listened, we have made improvements, and, with Thalamus, we are excited to make this vision a reality.” 

The organizations will collaborate to leverage their data, technology, and expertise to transform the medical residency and fellowship recruitment processes for applicants and programs. Their efforts will focus on increasing transparency, supporting equity through holistic review, and improving the learner experience by consolidating the fragmented interview management process. 

“We are thrilled to be collaborating with the AAMC to provide a comprehensive solution that will streamline graduate medical education recruitment processes,” said Jason Reminick, MD, MBA, MS, CEO and founder of Thalamus. “But even more, we are looking forward to building new and innovative tools that improve the experience, are cost-effective, and leverage data for the benefit of the medical education community and the advancement of our collective missions.” Dr. Reminick applied to residency in 2012 during an eventful recruitment season disrupted by Hurricane Sandy. “I’m particularly excited to provide applicants with a comprehensive platform to manage their interview season.” 

The collaboration between the AAMC and Thalamus will enable data-sharing and innovative research that will benefit the undergraduate to graduate medical education community and advance both organizations’ missions. The initiative also demonstrates the commitment of both organizations to addressing the concepts and themes outlined in the 2021 report from the Coalition for Physician Accountability’s Undergraduate Medical Education-Graduate Medical Education Review Committee.

In recent years, the AAMC has completed significant in-depth research and upgraded technology to enhance the Electronic Residency Application Service® (ERAS®) suite of application and selection tools, such as updating the MyERAS® application content, building analytics tools for institutions, and partnering on collaborative research initiatives. Thalamus has completed unique research related to the physician workforce, including how geography influences The Match® and specialty-specific interview practices. The Thalamus technology will continue the upgrade of the ERAS suite of application and selection tools. The AAMC and Thalamus remain committed to future innovations that will enable the ERAS program to continue to evolve faster and better. 

Beginning in June 2023, all ERAS residency and fellowship programs will receive complimentary access to Thalamus’ leading interview management platform, Thalamus Core and Itinerary Wizard, as well as Cerebellum, a novel data and analytics dashboard to assess recruitment outcomes, specifically from a diversity, equity, inclusion, and geographic perspective. Programs may also elect to purchase Thalamus’ video interview platform and Cortex, its technology-assisted holistic application review and screening platform. 

According to AAMC data, the U.S. is expected to experience a shortage of up to 124,000 physicians by 2034. Given the burnout and other challenges to the health care system caused by the COVID-19 pandemic, the AAMC and Thalamus look to use their collective expertise to promote a diverse and representative workforce that will enhance health care and patient outcomes. 

The data and research the AAMC and Thalamus have amassed to identify resident, fellow, and physician recruitment trends can potentially have a major impact on diversity in medicine and begin to address several well-established and longstanding systemic challenges. These efforts will support not only the application and selection processes in graduate medical education but also aim to improve the experiences of the U.S. physician workforce over the long term. 

Related Resources 

• Frequently Asked Questions 
• AAMC ERAS Collaboration Page
• Thalamus Collaboration Page

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Note for editors: Leaders from the AAMC and Thalamus are available to speak with media about this new collaboration and what it means for residency programs and applicants. 

The AAMC (Association of American Medical Colleges) is a nonprofit association dedicated to improving the health of people everywhere through medical education, health care, medical research, and community collaborations. Its members are all 157 U.S. medical schools accredited by the Liaison Committee on Medical Education; 13 accredited Canadian medical schools; approximately 400 teaching hospitals and health systems, including Department of Veterans Affairs medical centers; and more than 70 academic societies. Through these institutions and organizations, the AAMC leads and serves America’s medical schools and teaching hospitals and the millions of individuals across academic medicine, including more than 193,000 full-time faculty members, 96,000 medical students, 153,000 resident physicians, and 60,000 graduate students and postdoctoral researchers in the biomedical sciences. Following a 2022 merger, the Alliance of Academic Health Centers and the Alliance of Academic Health Centers International broadened the AAMC’s U.S. membership and expanded its reach to international academic health centers. Learn more at aamc.org. 

Thalamus is the premier, cloud-based interview management platform designed specifically for application to Graduate Medical Education (GME) training programs. The software streamlines communication by eliminating unnecessary phone calls/emails allowing applicants to book interviews in real-time, while acting as a comprehensive applicant tracking system for residency and fellowship programs. Thalamus provides comprehensive online interview scheduling and travel coordination via a real-time scheduling system, video interview platform, AI application screening/review tool (Cortex) providing technology-assisted holistic review, and first-in-class DEI-focused analytics dashboard (Cerebellum). Featured nationally at over 300+ institutions and used by >90% of applicants, Thalamus is the most comprehensive solution in GME interview management. For more information on Thalamus, please visit https://thalamusgme.com or connect with us on LinkedIn, Facebook, Instagram, Twitter, or YouTube. 

More proposals for reducing applications and interviews before medical resident matching

If the number of proposals for reform is an indicator of a brewing problem (and I think it is), it's time to think about the various application and interview processes that precede the NRMP resident match.  Here are three more...

J. Bryan Carmody (2020) Applying Smarter: A Critique of the AAMC Apply Smart Tools. Journal of Graduate Medical Education: February 2020, Vol. 12, No. 1, pp. 10-13.
https://doi.org/10.4300/JGME-D-19-00495.1

"Medical students today submit more residency applications than ever before. This trend is costly for students and imposes a substantial burden on program directors. Yet, despite a steady increase in the number of applications submitted per applicant, overall match rates have not improved.1 Put another way, applicants could collectively apply to fewer programs than they do now—and enjoy essentially the same overall match rate.

To assist students in determining the optimal number of residency programs to which they should apply, the Association of American Medical Colleges (AAMC) unveiled Apply Smart in 2016. The website notes that “there is a point where the relationship between the number of applications submitted and the likelihood of entry into a residency changes,” and suggests that students should consider limiting their applications at this point of diminishing returns.2 Responses to Apply Smart have been positive, with deans and program directors praising the tools and encouraging their use in counseling medical students.3–6

At first glance, the Apply Smart analyses seem highly informative. Yet, closer inspection reveals methodologic issues that introduce bias and suggest the need for improvements.
...
"Overapplication is costly, for applicants and programs alike. Given the incentives for medical students to overapply, it is unclear whether informational strategies alone can curtail overapplication. Until graduate medical education leaders are willing to support application caps or a fundamental restructuring of the Match to better allow signaling between applicants and programs,13 it is imperative that informational strategies present unbiased data that can aid students in applying to an appropriate number of programs. We cannot be satisfied for students to Apply Smart—we need to help them apply smarter."

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Joseph G. Monir (2020) Reforming the Match: A Proposal for a New 3-Phase System. Journal of Graduate Medical Education: February 2020, Vol. 12, No. 1, pp. 7-9.
https://doi.org/10.4300/JGME-D-19-00425.1

"The National Resident Matching Program (NRMP) was originally devised in 1952 to bring order to the chaotic residency application process.1 It currently has 2 phases: The Match and the Supplemental Offer and Acceptance Program (SOAP). Applications are submitted through the Electronic Residency Application Service (ERAS). While this is a significantly superior system to its predecessor, it is not flawless. As both residency applicants and positions have become more competitive, the flaws of the current system are becoming increasingly problematic for all involved parties.

"Despite evidence that applying to a greater number of programs does not improve Match rates,2 applicants feel pressured to apply to more and more programs to avoid going unmatched. In 2018, each applicant submitted a mean of 90.6 applications (mean of 60.3 for US graduates and 136.4 for international graduates).3 Applicants feel forced to accept interviews at programs which they have minimal interest in attending, to the detriment of other genuinely interested students. This, in turn, pressures other applicants to do the same lest they be disadvantaged. Whipple et al confirmed this vicious cycle using their computer model for competitive residencies, where they found that applying to the maximum number of programs “led to a poor result for the majority of students when all applicants undertook the strategy.”4

"As a result of this vicious cycle, residency programs are inundated with an average of 996 applications per program5 and have few reliable methods of identifying which of those applicants would seriously consider training there. Interviewing applicants who have no desire to attend that program is a costly endeavor. Gardner and colleagues found that, when accounting for both material and personnel costs, programs spent on average $18,648 ± $13,383 per open position and $1,221 ± $894 per interviewee.6

"Applying so broadly is costly for applicants as well. Fogel et al7 found that 84% of applicants believed residency interviews were too expensive, with 64% of applicants spending at least $2,500, and those entering competitive fields spending considerably more. In a study of orthopedic surgery applicants, for example, interview costs averaged $7,119 (range $2,500–$15,000).8 These figures do not include the cost of the applications themselves or externships, making the total residency application cost significantly higher.

"It is clear that the current system is fraught with inefficiency and that all involved parties would be better served by a system where applicants only apply to the programs they would seriously consider attending.

"The 3-Phase System
Transitioning the Match to a 3-phase process as outlined below could address the aforementioned problems.

"Phase 1
This phase would run from September through December and would function the same as the Match is currently. However, applicants would be limited in the number of positions for which they could apply. The results of Phase 1 would be e-mailed to applicants in the beginning of January. Most interviews already occur within this time frame, so most programs could continue using the systems they have in place. The majority of positions would be anticipated to fill in Phase 1.

"Phase 2
This phase would run from January through March. Those who do not match in Phase 1 would proceed to Phase 2. This would again function like the current Match, with applicants applying to open programs, attending in-person interviews, and submitting a rank list. There would be no cap on the number of Phase 2 applications, allowing applicants to apply broadly. The results of Phase 2 would be e-mailed to applicants in March. The majority of unfilled positions from Phase 1 would be expected to fill in Phase 2.

Phase 3
This phase would be the current SOAP week, with daily rounds of interviews and offers. The number of applicants and positions entering the SOAP would likely decrease significantly."
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Plast Reconstr Surg. 2019 Feb;143(2):634-639. doi: 10.1097/PRS.0000000000005254.
Solving Congestion in the Plastic Surgery Match: A Game Theory Analysis.
Molina Burbano F1, Yao A, Burish N, Ingargiola M, Freeman M, Stock J, Taub PJ.

Abstract
Plastic and reconstructive surgery is among the most competitive specialties in the residency match. Applicants seeking to maximize their chances of a successful match often submit numerous applications to the National Residency Matching Program. It is not uncommon for those applying to plastic and reconstructive surgery to apply to every program. The high application volume imparts significant time and financial burden for applicants and programs alike. Furthermore, it makes distinguishing between applicants with a genuine interest in a specific program and those who are merely hoping to improve their chances vastly more difficult. The authors sought to characterize trends in the match rate, as the number of integrated plastic and reconstructive surgery programs continues to increase. Furthermore, they reviewed the literature on game theory for possible solutions to residency application congestion. The authors propose the use of the game theory model to explain the observed results and show why an application limit is the most reasonable approach to address this issue.