Matching into an Orthopedic Residency: Which Application Components Correlate with Final Rank List Order?

Letter of Recommendation Characteristics Associated with Interview Offer to a Vascular Surgery Residency Program

BACKGROUND

Letters of recommendation (LOR) are considered by program directors (PDs) to be an integral part of the residency application. With the conversion of United States Medical Licensing Examination (USMLE) Step 1 to a binary pass/fail outcome, LORs will likely have higher important in the application process moving forward. However, their utility in securing an interview for a particular applicant remains undetermined. This study aims to identify the applicant and LOR characteristics associated with an interview invitation.

METHODS

Letter writer (n = 977) characteristics were abstracted from applications (n = 264) to an individual integrated vascular surgery residency program over 2 application cycles. A validated text analysis program, Linguistic Inquiry and Word Count, was used to characterize LOR content. Applicant, letter writer, and LOR characteristics associated with an interview invitation were determined using multivariable analysis.

RESULTS

Letter writers were 70.9% vascular surgeons (VS), 23.7% PDs, and 45.4% professors. Applicants offered an interview were more likely to come from a top 50 medical school (35.2% vs 25.8%, P = 0.013) and an institution with a home vascular program (45.5% vs 34.1%, P = 0.006). Alpha Omega Alpha membership was significantly associated with interview offer (28.4%, P < 0.001). A greater proportion of letters from VS was associated with an interview offer (P < 0.001) compared with letter writers of other specialties. One or more PD letters were significantly associated with an interview offer (79.55% vs 20.45%, P = 0.008), whereas number of letters from APDs was not significantly associated with interview offer. Letters written by away institution faculty were significantly associated with interview offer (75%, P < 0.001), whereas nonclinical letters were not. Presence of one or more letters from a chair (57.95% vs 42.05%, P = 0.015) or chief (67.05% vs 32.95%, P = 0.028) was significantly associated with interview offer. Letters for applicants offered an interview had more references to research and teaching, which were more common in letters written by versus Letters written by PDs were more likely to use assertive, advertising language in favor of applicants. There were no significant applicant, letter writer, or LOR characteristics associated with a top 20 rank.

CONCLUSIONS

Successful applicants were more likely to have LORs written by VS, PDs, and those of higher academic rank with references to research and teaching.

Let's Take a Look at the Tape: The Impact of ERAS Video Prompts on Interview Offerings for Orthopaedic Surgery Residency Applicants: A Prospective Observational Study

INTRODUCTION

Matching into an orthopaedic surgery residency consistently reinforces a competitive landscape, challenging the applicants and programs. A group of orthopaedic surgery residency programs implemented video prompts asking applicants to respond to a standardized question by video recording. Assessing the impact of this video on the decision to offer an interview can help guide programs and applicants through the interview process.

METHODS

Twenty residency applications to one institution requiring video prompts were randomly selected and deidentified. Thirteen experienced faculty from various orthopaedic surgery programs served as applicant reviewers. The reviewers evaluated the electronic residency application service (ERAS) application and determined whether they would grant the applicant an interview ("no," "maybe," or "yes") before and after watching the video prompt. The reviewer also scored the impact of the applicant's dress, facial presentation, and video background distractions on their evaluation of the video. Multivariable logistic regressions were conducted using a group of applicants where interview status was not impacted by the video compared with the group of applicants where the interview status changed after video review. An alpha value of 0.05 was used to define significance.

RESULTS

The video prompt impacted the decision to offer an interview 29.3% of the time; 15.8% were switched from "yes" or "maybe" to "no" and 13.5% were switched from "no" or "maybe" to "yes." For the positively impacted applicants, facial presentation score was significantly higher ( P = 0.005). No recorded variables were associated with decreased chance of interview.

DISCUSSION

Video prompts impacted the decision to offer interviews to orthopaedic surgery applicants approximately one-third of the time, with a similar number of applicants being positively and negatively impacted. Facial presentation score was associated with increased chance of interview, and no variables were associated with decreased chance of interview. Thus, the answer to the videos presumably negatively impacted applicants.

Gender Differences in Self-Description: A Linguistic Analysis of Orthopedic Surgery Residency Application Personal Statements

OBJECTIVE

The purpose of this study is to assess differences in language characteristics in personal statements written by male and female applicants to an orthopedic surgery residency program.

DESIGN

This is a blinded retrospective analysis of personal statements from all applicants to an orthopedic surgery residency training program during 1 application cycle. Language characteristics were analyzed using a linguistic analysis software. This software evaluated 19 variables, including word count, 4 summary language variables (analytical thinking, clout, authenticity, and emotional tone), and 14 additional word categories.

SETTING

Our study took place at [institution].

PARTICIPANTS

All applications submitted during the 2018-2019 residency application cycle were analyzed. 889 applicants were included in the study based on exclusion criteria, which omitted the 5 applicants who ultimately matched at our institution, as well as non-US citizens.

RESULTS

Word count was not statistically significant between groups. Amongst the summary language variables, authenticity was higher in female applicants (p = 0.0142). Of the selected word categories, males averaged a higher score in certainty (p = 0.0418), while females averaged higher scores in curiosity (p = 0.0102), perception (p = 0.0486), and attention (p = 0.0293).

CONCLUSIONS

Subtle differences exist in the language characteristics of personal statements written by male and female applicants to orthopedic surgery residency. The implications of our findings would be strengthened by new data on specific language characteristics and communication skills most desired by orthopedic program directors. Lastly, as evaluation metrics for residency applications continue to change, personal statements may assume an even more important role.

Orthopaedic Personal Statement Thematic Review: Does Topic Matter?

Introduction

In the process of applying into medical residency, the Electronic Residency Application Service (ERAS) requires critical documents including a personal statement. Utility of personal statements are questioned based on suspected congruity of the content within personal statements among those who apply into orthopaedic surgery. The goal of this study was to identify and categorize the thematic elements found within the 2021 to 2022 personal statements of orthopaedic surgery applicants at a single institution and assess a correlation to interview invitation.

Methods

Deidentified personal statements among 2021 to 2022 ERAS applicants were reviewed by the research staff and categorized into one of the proposed themes. Three hundred ninty-four applications passed initial screening filters, and 49 applicants were granted an interview. Proposed themes that were collected included: family of physician, working with hands, history of injury/disease, prior professional setting, immigration/travel, athlete/sports, reapplication, previous clinical experience, and other. χ2 test was used to analyze categorical themes and additional univariate group-to-group comparisons. Multivariate principal component analysis was performed to determine which themes were associated with interview invitation.

Results

There was a significant difference in theme selection for an applicant's personal statement (χ2 = 209.5, p < 0.001), but no statistical difference was observed between each individual categorical themes and interview selection. Univariate group-to-group comparison demonstrated greater interview rates between immigration/travel compared with reapplicant and family of physician compared with working with hands. Multivariate principal component analysis demonstrated immigration/travel as the theme with a positive correlation toward an interview invitation.

Conclusion

Despite a significant focus of the application process into orthopaedic surgery residencies, our single-institution study did observe specific themes that were more prevalent. There was an increased interview rate between applicant's themes for immigration/travel and family of physician when comparing groups. Immigration/travel was also identified as the only significant theme associated with interview invitation which may be due to the recent emphasis on promoting diversity within orthopaedic surgery.

Factors influencing the selection criteria of Saudi board orthopedic surgery applicants: a national survey of program directors

BACKGROUND

Annually, medical students vie to secure a seat with an orthopedic residency program. This rigorous competition places orthopedic surgery as one of the most competitive specialties in the medical field. Although several international studies have been published regarding the factors that influence program directors when choosing their ideal applicant, the data for Saudi Arabia in that regard is absent.

METHODS

In this cross-sectional study, we aimed to survey all orthopedic program directors regarding the factors that influence them when choosing their ideal orthopedic surgery applicant. A survey was sent to all program directors via email during the month of August 2022. A reminder was sent 2 weeks later to maximize the response rate. The survey was completed by 22 out of 36 orthopedic program directors, which gave us a response rate of 61.11%.

RESULTS

In this study, 22 orthopedic surgery program directors responded to our survey. When program directors were asked to rank the factors of residency selection criteria, the top ranked factors were good impression on interviews; prior experience in orthopedic surgery with, for example, electives; and performance on ethical questions during interviews, with means of 9.18, 8.95, and 8.82 out of 10, respectively. Furthermore, program directors preferred letters of recommendation from recommenders that they personally know, clinical experience such as electives taken at the program director's institution, and the quality of publications as the most important aspects of research. Most program directors (90.9%) relied on their residents' and fellows' opinions when selecting candidates, and 77.3% did not think gender has an influence on selection of applicants.

CONCLUSION

By providing comprehensive data regarding the factors that influence and attract program directors of orthopedic surgery when choosing residency candidates. With the data provided by this study, applicants for orthopedic surgery have the advantage of early planning to build a strong application that may help persuade program directors to choose them.

The Value of Signaling an Orthopaedic Surgery Program: A Survey to Orthopaedic Surgery Programs

INTRODUCTION

A new system was implemented by the Association of American Medical Colleges called the preference signaling program for the 2022 to 2023 orthopaedic surgery residency match. Applicants were able to signal 30 orthopaedic surgery programs to indicate high interest in a specific program. The purpose of this study was to address how important signaling was to an orthopaedic surgery program this 2022 to 2023 application cycle.

METHODS

A five-question survey was sent to orthopaedic surgery residency programs participating in the Electronic Residency Application Service this application cycle. Contact information was gathered through the Accreditation Council for Graduate Medical Education residency website and program websites.

RESULTS

Responses were obtained from 69 of the 151 programs (46%) contacted. The average number of applicants per program was 727 (range, 372 to 1031, SD 155). Thirty-four of 61 respondents (56%) stated that 100% of their interviewees signaled their program. Fifty-five of 61 respondents (90%) indicated that their interviewee pool consisted of 75% or more applicants who signaled. Applicants who signaled had a 24.4% (range, 12.77 to 47.41, SD 8.04) chance of receiving an interview. Applicants who did not signal had just a 0.92% (range, 0 to 13.10, SD 2.08) chance of receiving an interview. Fifty-four of the 63 applicants (86%) answered that signaling played an important role in considering an applicant for an interview.

CONCLUSION

Over half of the responding programs only interviewed applicants who signaled their program, and over 90% of programs' interview lists consisted of at least 75% of signaling applicants. Eighty-six percent of programs indicated that signaling played an important role in considering an applicant for an interview. Applicants who signaled were 26.5 times more likely to receive an interview than those who did not (P < 0.0001). With this information, applicants can narrow down their list of programs to apply to, knowing that their signal to a program will give them a better chance at receiving an interview.

Comparative Evaluation of the Electronic Residency Application Service Versus the Plastic Surgery Common Application to a Single Institution in the 2022 Integrated Plastic Surgery Match

BACKGROUND

The Plastic Surgery Common Application (PSCA) has emerged as a low-cost alternative application portal to the Electronic Residency Application Service (ERAS) for integrated plastic surgery applicants. During the 2021 to 2022 application cycle, our plastic surgery residency program accepted both the PSCA and ERAS applications to help recruit candidates otherwise deterred by prohibitively high application costs. We sought to determine how the PSCA compared with the ERAS application in a standardized review of applications scores.

METHODS

The PSCA and ERAS applications from 28 candidates who received interviews from the Keck School of Medicine were analyzed. These 56 applications were randomly assigned across 22 independent reviewers. Each reviewer scored applications on a scale of 1 to 5 with regard to communication skills, leadership, intellectual curiosity, compatibility with the program, service, and perseverance. Mean scores between the applications were compared using 2-tailed z tests, with statistical significance set at P < 0.05.

RESULTS

The 56 residency applications had a combined mean score of 4.21 (95% confidence interval [CI], 4.13-4.29). The mean score of PSCA applications (4.19; 95% CI, 4.08-4.31) did not significantly differ from the mean score of ERAS applications (4.24; 95% CI, 4.12-4.35; P = 0.57). The PSCA and ERAS applications did not have a significant difference in the mean scores for any review category.

CONCLUSION

There was no difference between the overall scores and the scores of each review category between the PSCA and ERAS applications, suggesting that the PSCA may be a reasonable alternative to ERAS for medical students applying to plastic surgery residency.

Examining the Factors Influencing Applicants' Placement on One General Surgery Program's Rank Order List

PURPOSE

Surgery residency applications include variables that determine an individual's rank on a program's match list. We performed this study to determine which residency application variables are the most impactful in creating our program's rank order list.

METHODS

We completed a retrospective examination of all interviewed applicants for the 2019 match. We recorded United States Medical Licensing Examinations (USMLE) step I and II scores, class quartile rank from the Medical Student Performance Evaluation (MSPE), Alpha Omega Alpha (AOA) membership, geographic region, surgery clerkship grade, and grades on other clerkships. The MSPE and letters of recommendation were reviewed by two of the authors and assigned a score of 1 to 3, where 1 was weak and 3 was strong. The same two authors reviewed the assessments from each applicant's interview and assigned a score from 1-5, where 1 was poor and 5 was excellent. Univariate analysis was performed, and the significant variables were used to construct an adjusted multivariate model with significance measured at P < .05.

RESULTS

Univariate analysis for all 92 interviewed applicants demonstrated that USMLE step 2 scores (P = .002), class quartile rank (P = .004), AOA status (P = .014), geographic location (P < .001), letters of recommendation (P < .001), and interview rating (P < .001) were significant in predicting an applicant's position on the rank list. On multivariate analysis only USMLE step 2 (P = .018) and interview (P < .001) remained significant.

CONCLUSION

USMLE step 2 and an excellent interview were the most important factors in constructing our rank order list. Applicants with a demonstrated strong clinical fund of knowledge that develop a rapport with our faculty and residents receive the highest level of consideration for our program.

Program Director Opinions of Virtual Interviews: Whatever Makes my Partners Happy

OBJECTIVE

To assess the processes and outcomes of 2021 colon and rectal surgery match season: one of the first National Resident Matching Program (NRMP) match to conduct uniformly virtual interviews for all programs and candidates due to the Covid-19 pandemic. Since this if the first-year interviews were held entirely virtual for a (NRMP) match season, we sought to determine: (1) How did program directors (PDs) in this year's fellowship conduct their virtual interviews? (2) Were any of these conduct decisions associated with the PD satisfaction with the resulting match? (3) What is the PDs opinion of how interviews should occur next year if COVID-19 is not a factor?

DESIGN AND SETTING

The authors sent an anonymous survey to the PDs of all programs participating in the 2021 colon and rectal surgery residency match directly following match day 2020.

PARTICIPANTS

Forty-one colon and rectal residency PDs (70% response rate) responded to the survey (78% Male) representing a range of experience (M = 7.61, SD = 5.66, years as PD at current institution), and program type (77.5% Academic, 7.5% Independent Academic Medical Center, 15% Nonacademic).

RESULTS

While programs utilized several different platforms, conducted various forms of training for their faculty, and provided applicants with different types of information, interview day(s) across the specialty are reported to have proceeded smoothly. PDs as a whole were very satisfied with their match results this year (M = 4.65, SD = .66), and this satisfaction was not impacted by virtual interview decisions or processes. However, only 55% of PDs agree or strongly agree that next year's interviews should be virtual regardless of COVID-19, a judgement solely influenced by the opinion of other program faculty on virtual interviews, regardless of satisfaction with match or comfort with technology.

CONCLUSION

While PDs report high satisfaction with virtual interview processes and outcomes, there is less agreement that colon and rectal surgery residency interviews should move to a solely virtual platform.

Virtual interviews - Utilizing technological affordances as a predictor of applicant confidence

PURPOSE

In the midst of a pandemic, residency interviews transitioned to a virtual format for the first time. Little is known about the effect this will have on the match process. The study aim is to evaluate resident application processes and perceived outcomes.

METHODS

An electronic survey was distributed to 142 colon and rectal surgery residency applicants (95% of total).

RESULTS

A total of 77 applicants responded to the survey (54% response rate). Applicants reported high levels of satisfaction with virtual interviews but less comfort. Utilizing the mute button and using notes in a different way from face-to-face interviews were significantly associated with applicant confidence that they ranked the right program highest. A majority of applicants (73%) would recommend virtual interviews next year even if COVID-19 is not a factor.

CONCLUSION

While applicants appear generally satisfied with virtual interviews, they also reported less comfort. Applicant confidence was predicted by utilizing the unique technological affordances offered by the virtual platform.

National Resident Matching Program Rank Order and Performance in an Internal Medicine Residency

OBJECTIVES

Prospective first-year house staff and residency program leaders spend substantial time, effort, and expense preparing a rank order list for the National Resident Matching Program (NRMP). Previous studies have mostly shown minimal or no relation between rank order and subsequent resident performance, raising questions about the value of this process. Furthermore, no previous studies have been done with Internal Medicine residencies. As such, the purpose of this study was to compare NRMP rank order to multiple objective outcomes of an Internal Medicine residency.

METHODS

A retrospective cohort of Internal Medicine residents from five consecutive graduating classes, trained between July 1, 2013 and July 31, 2020, were evaluated for five objective outcomes: Accreditation Council for Graduate Medical Education (ACGME) milestones, faculty rankings of quality, National In-Training Examination scores, chief resident attainment, and fellowship attainment. Outcomes were analyzed in relation to eight potential predictors: NRMP rank, medical school type and grades, immigration status, added qualifications, sex, age and US Medical Licensing Examination (USMLE) scores, using univariate and multivariate analyses.

RESULTS

From a cohort of 61 residents, 56 were eligible. All eligible residents' data were included, for a participation rate of 100% (56 of 56). There were no statistically significant univariate or multivariate predictors for the endpoint of fellowship attainment. Higher USMLE scores were predictive of chief resident status in univariate analysis only. NRMP rank was significantly correlated with ACGME milestones in the univariate analysis. The multivariate analysis revealed that higher USMLE score was statistically significantly predictive of more favorable milestones, faculty ranking, and National In-Training Examination score.

CONCLUSIONS

Higher USMLE score was statistically significantly associated with multiple favorable objective residency outcomes in an Internal Medicine residency. A better NRMP rank was correlated with favorable ACGME milestones in univariate analysis, but USMLE score emerged as the strongest predictor in multivariate analysis.

The Geographic Movement Patterns and Career and Personal Interests of Orthopaedic Surgery Residents in the United States

Orthopaedic surgery continues to be a highly desired residency specialty for graduating medical students in the United States. The geographic preferences and trajectories of orthopaedic surgery applicants are not well understood.

Medical Student Mentorship in Orthopaedic Surgery

Mentorship is a key aspect of medical education, but the availability and quality of mentorship varies considerably between institutions. The lack of standardization results in information asymmetry and creates notable inequities. This disparity is particularly important for students interested in pursuing competitive specialties, such as orthopaedic surgery. The purpose of this study was to (1) demonstrate the importance of mentorship in orthopaedics, (2) provide a framework for orthopaedic surgeon mentors, and (3) guide medical students interested in activating and expanding their networks.

Personal Statements in General Surgery: An Unrecognized Role in the Ranking Process

OBJECTIVE

Personal statements are a requirement of general surgery residency applications. Yet, their role in an applicant's final rank within a program remains unclear. This study explores the language used in personal statements to differentiate applicants in the general surgery residency ranking process.

DESIGN

A textual analysis of general surgery residency applicant personal statements was performed. Using inductive coding and grounded theory, 3 main themes from personal statements were identified: my story, my future, my goals. These themes were utilized to build a dictionary consisting of over 400 descriptive terms in multiple categories. Data was extracted using the Linguistics Inquiry and Word Count program, which can linguistically determine basic characteristics from text. The data was stratified according to final rank and gender for analysis, using correlation and descriptive statistics.

SETTING

Large, urban, academic general surgery residency program.

PARTICIPANTS

One hundred nineteen personal statements during the 2018 to 2019 application cycle were analyzed. All applicants were interviewed and considered for inclusion on our final rank list.

RESULTS

There were 68 (57%) females on the final rank list with no difference in the distribution of gender between those in the top and bottom halves (p = 0.11). Overall, personal statements for the top applicants scored higher in grit than those in the bottom half (median 0.42% vs 0.35%, p = 0.03). Males ranked in the top half had less use of agentic (p = 0.04) and efficient/organized (p = 0.03) words when compared with males ranked in the bottom half. In contrast, females ranked in the top half used more grit words compared to those in the bottom half (median 0.45% vs 0.35%, p = 0.004).

CONCLUSIONS

Linguistic differences existed in the personal statements of top- and bottom-ranked applicants to a general surgery residency program. These findings provide an adjunctive tool for differentiating applicants based on this underutilized component of the ranking process.