Signals and interviews in the transition from medical school to residency

Late last year I was interviewed by Dr. Seth Leopold, who is a Professor in the Department of Orthopaedics and Sports Medicine at the University of Washington School of Medicine, and Editor-in-Chief of the journal Clinical Orthopaedics and Related Research.   That interview has just appeared ahead of print on the journal's website: 

A Conversation with … Alvin E. Roth PhD, Economist, Game Theorist, and Nobel Laureate Who Improved the Modern Residency Match  by Leopold, Seth S. MD, Clinical Orthopaedics and Related Research: April 7, 2021 - Publish Ahead of Print - doi: 10.1097/CORR.0000000000001758

Here's one part of our Q&A:

Dr. Leopold:You once commented in a Not the Last Word column in CORR® that the Match might be improved if a bit more room could be made for candidates to send “signals” to programs that indicate particular interest[5]; if you could make one change to the Match right now to make it fairer all around, what would that change be?

Dr. Roth: I don’t yet know enough about the whole pre-Match process of applications and interviews to answer that confidently. I’m hoping to gain access to data that will illuminate more clearly how applications lead to interviews, and how interviews interact with other kinds of information to influence what rank-order lists are submitted by applicants and programs. Some of that process is surely in flux, between the pandemic causing interviews to be conducted remotely and the United States Medical Licensing Examination Step 1 going pass/fail. Signaling is a way to address miscoordination in interviewing (such as whether too many interviews are concentrating on too few candidates), but there are other ways the interview process might be broken that might better be addressed by other tweaks in how interviews are organized.

Dr. Leopold:I believe the study you’re proposing here would find a very attentive audience, both in medical schools and residency programs across the country, especially competitive ones like orthopaedic surgery. Based on other kinds of markets you’ve evaluated—I recognize I’m asking you to speculate—what do you think you might find here?

Dr. Roth: Presently, in at least some specialties, many interviews are conducted for each residency and fellowship position. It could be that interviews play a critical role in allowing programs and applicants to assess each other, regardless of the other information they may have. But it could also be that at least some interviews are being conducted “defensively,” because all the interviews that others are participating in make it hard for each program or applicant to predict how likely any interview will lead to a position being offered and accepted in the Match. So, it is possible that there is “too much” interviewing, in the sense that in perhaps predictable ways, some programs are interviewing some candidates they can virtually never hire, and some candidates they would never want to hire. Conversely, applicants are interviewing for some jobs they have hardly any chance of being offered, and some they sensibly think they won’t need to take. Of course, some things can be predictable even if they can’t be predicted by individual applicants and programs with the information they now have available. It might therefore be possible to suggest institutional reforms that would help reduce the uncertainty in deciding which interviews to offer. That might also reduce the number (and costs) of interviews. (In just such a way, the Match helped solve the problem of uncertainty involved in offers and acceptances, back when offers were exploding.) And there’s a possibility that fewer interviews could make everyone better off in terms of expectations, particularly if participants on both sides of the market will feel a reduced need to do so many interviews if everyone else reduces the number they do. But as you say, until we can look into this carefully, I’m just speculating.