Rejecting Reforms, Yet Calling for Change: A Qualitative Analysis of Proposed Reforms to the Residency Application Process

Abstract

PurposeAnnual increases in the number of residency applications burden students and challenge programs. Several reforms to the application process have been proposed; however, stakeholder input is often overlooked. The authors examined key stakeholders' opinions about several proposed reforms to the residency application process and identified important factors to guide future reforms. MethodUsing semistructured interviews, the authors asked educational administrators and trainees to consider 5 commonly proposed reforms to the residency application process: Match to obtain residency interviews, preference signaling, application limits, geographic preference disclosure, and abolishing the Match. The authors conducted a modified content analysis of interview transcripts using qualitative and quantitative analytic techniques. Frequency analysis regarding the acceptability of the 5 proposed reforms and thematic analysis of important factors to guide reform were performed. Fifteen-minute interviews were conducted between July and October 2019, with data analysis completed during a 6-month period in 2020 and 2021. ResultsParticipants included 30 stakeholders from 9 medical specialties and 15 institutions. Most participants wanted to keep the Match process intact; however, they noted several important flaws in the system that disadvantage students and warrant change. Participants did not broadly support any of the 5 proposed reforms. Two themes were identified: principles to guide reform (fairness, transparency, equity, reducing costs to students, reducing total applications, reducing work for program directors, and avoiding unintended consequences) and unpopular reform proposals (concern that application limits threaten less competitive students and signaling adds bias to the system). ConclusionsKey stakeholders in the residency application process believe the system has important flaws that demand reform. Despite this, the most commonly proposed reforms are unacceptable to these stakeholders because they threaten fairness to students and program workload. These findings call for a larger investigation of proposed reforms with a more nationally representative stakeholder cohort.The number of residency applications submitted by U.S. medical students has increased substantially during the past 2 decades. Since the Electronic Residency Application Service (ERAS) launched in 1996, there has been a near-linear, year-over-year increase in the number of applications submitted per MD student. [1][2][3][4][5][6] These increases are not strongly correlated with the number of residency positions available in the National Resident Matching Program (NRMP) Match, 7 and they are not driven by DO or international medical students. 2,8 This trend raises questions about the sustainability of the current residency application process. [9][10][11][12][13]

Analysis of Proposed Avtur Rental Rates at Hang Nadim Airport, Batam

“…FTZ sering kali dirancang sebagai bagian dari Special Economic Zone (SEZ) untuk meningkatkan kinerja ekspor nasional dan untuk menarik investasi asing [11]. Kawasan perdagangan bebas merupakan instrumen penting dalam ekonomi global yang menydiakan perdagangan dan investasi lintas negara [12]. Dengan adanya regulasi yang mendukung, kawasan perdagangan bebas ini dapat memberikan manfaat ekonomi yang signifikan bagi negara-negara yang mengimplementasikannya.…”

Easing the Transition From Undergraduate to Graduate Medical Education

“…Other recommendations offered by our colleagues are related to developing a common competency framework with aligned assessments, introducing workforce diversity evaluations and equitable recruitment practices, and increasing attention to data-driven studies to improve the UME–GME transition. The authors of several articles 1–4 in this cluster emphasize the need for greater transparency at institutional and national levels and the need for pilot studies of novel programs that could improve matching with preferred programs and, at the same time, produce a more even distribution of physicians and a strengthened medical workforce in the United States.…”

“…The idea of reducing residency application numbers through application “limits” was the most popular possible solution endorsed in a qualitative study performed by Dacre et al 4 In this project, authors used semistructured interviews to ask 30 participants from 9 medical specialties about 5 residency application reform proposals. The proposals were (1) using a match process to obtain interviews, (2) having preference signaling during the application process, (3) introducing application limits, (4) disclosing geographic preference(s), and (5) eliminating the Match.…”

“…In this issue of our journal, we have several articles 1–5 on the transition from undergraduate medical education (UME) to graduate medical education (GME). These articles have been written by and for stakeholders in health professions education, including learners, teachers, and leaders in academic medicine and health systems.…”