Mastering the Match: Recruiting a Successful Surgery Resident

Conceptualizing Fit in Surgical Residency Selection: The Experience in Otolaryngology-Head and Neck Surgery

OBJECTIVE

Fit is a crucial factor in surgical residency selection, but how this abstract concept is applied in practice is poorly understood. Person-environment (PE) fit theory suggests that there are multiple fit domains that can clarify usage: person-job, person-organization, and person-workgroup fit. We used PE fit theory to explore how otolaryngology residency selection committee (RSC) members operationalize the concept of fit.

DESIGN

One-hour focus groups were conducted in November 2022. Interview questions explored participants' definitions and uses of fit in the resident selection process. Transcripts were analyzed using directed qualitative content analysis to generate themes and evaluate how these align with PE fit domains.

SETTING

Society of University Otolaryngologists Annual Meeting breakout session in November 2022.

PARTICIPANTS

21 RSC members from 20 different otolaryngology-head and neck surgery departments participated in three seven-person focus groups.

RESULTS

Participants described aspects of fit that aligned with PE fit domains. Person-job included how applicants fit as both surgeons and residents. Person-organization included how applicants fit with the program's characteristics, program's mission, and the local community. Person-workgroup emphasized how applicants fit with current residents. Various challenges in the selection process limited the extent to which PE fit was operationalized, including 1) ambiguous uses of fit, 2) unique features of the match process, 3) lack of outcomes data for selection decisions, and 4) interactions with diversity, equity, and inclusion goals.

CONCLUSIONS

Fit manifests in various ways during the surgical residency selection process that parallel domains of PE fit theory. Recommendations are made to assist programs in using fit in resident selection, including clearly articulating definitions of fit to increase transparency in conversations. Further work on selection challenges is needed to maximize the utility of fit in practice.

Applicants Performance in Interview for a General Surgery Residency Pre- and During Coronavirus Disease-19 Pandemic

INTRODUCTION

The coronavirus disease-19 (COVID-19) pandemic has created a shift from traditional in-person interviews for a residency position to a virtual platform over the last 2 y (2020-2021). With this significant shift, there is controversy about how this may affect applicant performance. We hypothesized that applicants scored higher during virtual interviews than in-person interviews.

METHODS

Applicants interviewed for postgraduate year 1 positions at a single university-based residency program over six interview cycles were divided into group A (4 cycles, pre-COVID-19) and group B (2 cycles, during COVID-19). All candidates were interviewed by faculty and senior surgical residents and scored on letters of recommendation (LOR), personal statement (PS), research (RS), the way the candidate represented themselves (RP), interest in the geographic area (IN), and degree of connection between candidate and interviewer (CN). Differences in mean scores between candidates in these two groups were assessed using an independent-sample t-test.

RESULTS

Of 332 total applicants, 187 (56.3%) were in group A (cycles 2016-2019) and 145 (43.7%) were in group B (cycles 2020-2022). Group-B had higher United States Medical Licensing Examination Step 2 and Step 1 mean (standard deviation) scores (251.1 ± 10.6 versus 247.6 ± 11.8, P = 0.006 and 241.1 ± 10.3 versus 238.4 ± 10.4, P = 0.02). Group A scored higher median [interquartile range] in CN (4.4 [4.1, 4.6] versus 4.2 [3.9, 4.6], P = 0.005) and IN (4.3 [4.0, 4.5] versus 4.1 [3.8, 4.4], P = 0.002), while group B scored higher in LOR (4.3 [4.1, 4.6] versus 4.2 [3.9, 4.5], P = 0.011) and PS (4.3 [4.1, 4.4] versus 4.1 [3.8, 4.4], P = 0.001). No differences were noted between groups A and B in RS (3.9 [3.4, 4.5] versus 4.1 [3.5, 4.5], P = 0.108) or RP (4.4 [4.1, 4.7] versus 4.4 [4.2, 4.8], P = 0.317). No differences in the median [interquartile range] total scores of personal characteristic categories (25.1 [23.7, 26.5] versus 25.1 [23.8, 26.7], P = 0.703) were observed.

CONCLUSIONS

From a program perspective, there were no differences between groups; however, candidates in the pre-COVID era scored higher in CN and IN, while those who interviewed virtually had higher scores in LOR and PS. Applicants perceptions may differ regarding in-person versus virtual interviews.

Designing the "match of the future": challenges and proposed solutions in the interview and match phase of the UME-GME transition

This review focuses on the interview and match process with the purpose of broadly reviewing challenges in the current surgical residency selection process, detailing potential solutions, and identifying future avenues of investigation.

Faculty Scoring of General Surgery Residency Interviewees: A Comparison of In-Person and Virtual Interview Formats

OBJECTIVE

With new rules regarding social distancing and non-essential travel bans, we sought to determine if faculty scoring of general surgery applicants would differ between the in-person interview (IPI) and virtual interview (VI) platforms.

DESIGN

A single institution, retrospective review comparing faculty evaluation scores of applicant interviewees in the 2019 and 2020 MATCH® application cycles (IPIs) and the 2021 and 2022 application cycle (VIs) was conducted. Faculty scored applicants using a 5-point Likert scale in 7 areas of assessment and assigned each student to 1 of 4 tiers (tier 1 highest). A composite score for the 7 assessments (maximum score 35) was calculated. Mean and composite scores and tiers were compared between VI and IPI cycles and adjusted for within-interviewer correlations. The variance of the 2 groups were also compared.

SETTING

Harbor-UCLA Medical Center, an academic, tertiary care hospital.

PARTICIPANTS

General Surgery applicants for the 2019 to 2022 MATCH® application cycles.

RESULTS

Four hundred forty-one faculty IPI ratings of General Surgery applicants were compared to 531VI ratings. No difference in mean composite scores, individual assessments, or tier ranking. Less variance was identified in the VI group for academic credentials (0.6 vs 0.6, p = 0.01), strength of letters (0.7 vs 0.4, p = 0.005), communication skills (0.4 vs 0.6, p = 0.01), personal qualities (0.2 vs 0.5, p = 0.02), overall sense of fit for program (0.6 vs 0.9, p = 0.01), and tier ranking (0.3 vs 0.4, p = 0.004).

CONCLUSIONS

Faculty ratings of General Surgery applicants in the VI format appear to be similar to IPI. However, faculty ratings of VI applicants demonstrated less variability in scores in most assessments. This finding is potentially concerning, as it may suggest an inability of VI to detect subtle differences between applicants as comparted to IPI.

Identifying Potential Attrition during the Residency Applicant Screening Process Using a Situational Judgment Test

OBJECTIVE

As USMLE Step 1 moves to pass/fail, residency programs are seeking alternate interview selection processes. Attrition in general surgery is reported as high as 26%. Thus, it is important to ensure that programs are selecting and matching applicants with shared values. Situational judgment tests (SJTs) measure educational and cultural values by posing ambiguous situations and individuals rate the effectiveness of possible reactions. SJTs have previously been shown to identify job applicants with shared values while promoting diversity. Scoring categories are high, moderate, or low values congruence. We sought to explore predictive validity of the SJT relative to program attrition.

DESIGN

Residents who matched into our program between 2018 and 2021 completed the SJT. We tracked attrition.

SETTING

UT Health San Antonio, Texas PARTICIPANTS: Fifty-six categorical general surgery residents RESULTS: Per SJT ratings, the numbers of residents who had high, moderate, and low values congruence were 27, 16, and 13, respectively. Attrition numbers for residents who scored high and moderate congruence were similar, indicating that these ratings were indistinguishable. As such, we combined those 2 categories to create a 2 × 2 matrix and used signal detection theory as a framework for analysis. Overall attrition was 16.1% (9/56). Of the 43 residents who scored high or moderate congruence, 90.7% remained in the program. There was a 9.3% chance of attrition for these residents. Of the 13 residents who scored low congruence, 38.5% attrited. While scoring as low congruence on the SJT does not definitively indicate attrition, it does indicate that attrition is 4.14 times more likely for these residents (chi-square, p = 0.0121).

CONCLUSIONS

One of the most important aspects of residency applicant selection and interviewing is mitigating risk by identifying applicants who carry a high risk of attrition. The SJT significantly identifies at-risk applicants.