Some thoughts on the medical match in JAMA:
Potential Implications of COVID-19 for the 2020-2021 Residency Application Cycle
Maya M. Hammoud, MD, MBA1; Taylor Standiford, BS1; J. Bryan Carmody, MD, MPH2
JAMA. Published online June 03, 2020. doi:10.1001/jama.2020.8911
"Even before COVID-19, calls to reform the residency selection process were becoming more frequent.1,2 Many issues are related to the increasing number of programs to which applicants apply. In 2019-2020, applicants from US medical schools applied to an average of 65 programs, and international medical graduates (IMGs) applied to an average of 137 programs.3 This number of applications likely does not improve match rates and imposes a substantial cost on applicants and a potentially unmanageable load on program directors.
"It is possible that the disruptions caused by COVID-19 may result in an increase in the number of applications and further stress this already challenged system. Due to testing center closures, many applicants have been unable to take portions of the United States Medical Licensing Examination (USMLE). This is especially critical for IMGs, who must pass the Step 2 Clinical Skills Examination to obtain certification from the Educational Commission for Foreign Medical Graduates and apply to US residency programs. Additionally, medical schools have shortened clerkships, shifted to virtual rotations, and canceled away electives, all of which may reduce student opportunities to obtain meaningful faculty evaluations, letters of recommendation, and signal their interest to programs. Students will encounter significant uncertainty regarding how their applications will be evaluated and may respond by applying to even more programs.
Program directors may have difficulty identifying applicants to interview without use of traditional screening metrics. Yet, challenges will persist even after interviews are offered; if travel disruptions and social distancing persist into the interview season, programs may be unable to offer in-person interviews. Temporary solutions, such as conducting virtual interviews or waiving requirements for USMLE scores and letters of recommendation, will be necessary for the selection process to function. But these stopgap solutions may exacerbate existing problems with residency selection and lead to undesirable consequences. For instance, the use of virtual interviews could result in applicants participating in more interviews. Currently, the number of interviews an applicant attends is limited by time and travel expense, but these constraints will be less relevant with virtual interviews. Yet because many programs rely on the same screening metrics, many programs already overinvite the same pool of highly-qualified applicants, with just 7% to 21% of the applicant pool filling half of all interview slots in some specialties.4 The result of those applicants accepting more interview invitations could be an increase in both the number of unmatched applicants and unfilled programs.
Potential Implications of COVID-19 for the 2020-2021 Residency Application Cycle
Maya M. Hammoud, MD, MBA1; Taylor Standiford, BS1; J. Bryan Carmody, MD, MPH2
JAMA. Published online June 03, 2020. doi:10.1001/jama.2020.8911
"Even before COVID-19, calls to reform the residency selection process were becoming more frequent.1,2 Many issues are related to the increasing number of programs to which applicants apply. In 2019-2020, applicants from US medical schools applied to an average of 65 programs, and international medical graduates (IMGs) applied to an average of 137 programs.3 This number of applications likely does not improve match rates and imposes a substantial cost on applicants and a potentially unmanageable load on program directors.
"It is possible that the disruptions caused by COVID-19 may result in an increase in the number of applications and further stress this already challenged system. Due to testing center closures, many applicants have been unable to take portions of the United States Medical Licensing Examination (USMLE). This is especially critical for IMGs, who must pass the Step 2 Clinical Skills Examination to obtain certification from the Educational Commission for Foreign Medical Graduates and apply to US residency programs. Additionally, medical schools have shortened clerkships, shifted to virtual rotations, and canceled away electives, all of which may reduce student opportunities to obtain meaningful faculty evaluations, letters of recommendation, and signal their interest to programs. Students will encounter significant uncertainty regarding how their applications will be evaluated and may respond by applying to even more programs.
Program directors may have difficulty identifying applicants to interview without use of traditional screening metrics. Yet, challenges will persist even after interviews are offered; if travel disruptions and social distancing persist into the interview season, programs may be unable to offer in-person interviews. Temporary solutions, such as conducting virtual interviews or waiving requirements for USMLE scores and letters of recommendation, will be necessary for the selection process to function. But these stopgap solutions may exacerbate existing problems with residency selection and lead to undesirable consequences. For instance, the use of virtual interviews could result in applicants participating in more interviews. Currently, the number of interviews an applicant attends is limited by time and travel expense, but these constraints will be less relevant with virtual interviews. Yet because many programs rely on the same screening metrics, many programs already overinvite the same pool of highly-qualified applicants, with just 7% to 21% of the applicant pool filling half of all interview slots in some specialties.4 The result of those applicants accepting more interview invitations could be an increase in both the number of unmatched applicants and unfilled programs.
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