The Residency Application Process: Pursuing Improved Outcomes Through Better Understanding of the Issues

Abstract

The residency application process requires that applicants, their schools, and residency programs exchange and evaluate information to accomplish successful matching of applicants to postgraduate training positions. The different motivations of these stakeholders influence both the types of information provided by medical schools and the perceived value and completeness of information received by residency programs. National standards have arisen to shape the type and format of information reported by medical schools about their students, though criticisms about the candor and completeness of the information remain. Growth in the number of applicants without proportional expansion of training positions and continued increases in the number of applications submitted by each applicant contribute to increases in the absolute number of applications each year, as well as the difficulty of evaluating applicants. Few standardized measures exist to facilitate comparison of applicants, and the heterogeneous nature of provided information limits its utility. Residency programs have been accused of excluding qualified applicants through use of numerical screening methods, such as United States Medical Licensing Examination (USMLE) Step 1 scores. Applicant evaluation includes review of standardized measurements such as USMLE Step 1 scores and other surrogate markers of future success. Proposed potential improvements to the residency application process include limiting applications; increasing the amount and/or types of information provided by applicants and by residency programs; shifting to holistic review, with standardization of metrics for important attributes; and fundamental reanalysis of the residency application process. A solution remains elusive, but these approaches may merit further consideration.

Student Expenses in Residency Interviewing

“…This trend raises costs and strains resources for students and programs despite a sustained match rate for US allopathic graduates of around 94%. 1 , 5 , 16 – 21 Our report also draws attention to the days lost from education in the fourth year of medical school at a time when national curricular innovations increasingly emphasize the crucial role of the final year in achieving competencies and transitioning to the residency stage of education.…”

A Narrative Review of the Evidence Supporting Factors Used by Residency Program Directors to Select Applicants for Interviews

“…Several specialties have investigated the residency application process to better identify applicants who would be suited to both the specialty and the specific residency program. [46][47][48][49] These initiatives, cited here from general surgery, orthopedics, and family medicine, share common themes: de-emphasis of Step 1 scores, standardized evaluation letters, improvements in the MSPE to include student progress in various competencies, holistic file review, and evaluating for personal characteristics thought to be important to the specialty in question.…”

Pre-matriculation clinical experience positively correlates with Step 1 and Step 2 scores

“…Despite advances in a more holistic approach to medical school admissions, the selection of applicants into residency is determined, in large part, by their United States Medical Licensing Exam (USMLE) Step 1 and Step 2 scores. 1 – 3 Residency program directors note that this is often a pivotal factor when deciding whether or not to offer an applicant an interview. 2 , 4 Despite evidence against this practice and pleas to the contrary, the USMLE Step 1 and Step 2 will continue to play a large role in determining the potential choices future that residency applicants have in choosing their medical specialty.…”

“…2 , 4 Despite evidence against this practice and pleas to the contrary, the USMLE Step 1 and Step 2 will continue to play a large role in determining the potential choices future that residency applicants have in choosing their medical specialty. 1 , 3 …”