The personal interview: assessing the potential for personality similarity to bias the selection of orthopaedic residents

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.

Examining interviewer bias in medical school admissions: The interplay between applicant and interviewer gender and its effects on interview outcomes

Selection interviews have long been integral to medical school admissions, yet their limited predictive validity and susceptibility to bias raise concerns. This study delves into potential interviewer bias within the dynamics of interviewee and interviewer gender. We analyze a dataset of 5,200 applicants and over 370 selection committees engaged in semi-structured interviews from 2006 to 2019 at a large German medical school with multiple linear and non-linear regression analyses. Our findings reveal that all-female committees tended to award male candidates, on average, one point more than their female counterparts, significantly enhancing the chances of submission for male applicants despite lower academic grades, which constituted 51% of the selection process points. All-male and mixed-gender committees exhibited similar ratings for both genders. The role of valuing voluntary services emerged prominently: all-male and mixed committees acknowledged women's volunteer work but not men's, while all-female committees demonstrated the opposite pattern. Our results attribute variations in interview outcomes to the absence of standardization, such as insufficient interviewer training, divergent rating strategies, variations in interviewer experience, and imbalances in candidate allocation to selection committees, rather than to a "gender bias", for example by favoritism of males because of their gender.

Encountering Bias: Examining Biases and Stereotypes in the Evaluation Process Among Expert Psychologists During Specialization Exams

The study of cognitive biases in job interviews has garnered significant attention due to its far-reaching implications for the economy and society. However, little research has focused on the biases exhibited by expert psychologists serving on psychology specialization examination committees. As such, this study has conducted a comprehensive examination of biases within the specialization exam in Israel. One additional objective of the research is to assess the levels of distress experienced by examinees following the examination. Questionnaires were administered to 418 psychologists participating in the clinical and educational psychology specialization exams. The findings unveiled several noteworthy outcomes. Firstly, several biases were identified, including ethnic stereotypes, biases stemming from cognitive load, and more. Secondly, examinees who presented a cognitive-behavioral therapy (CBT) case experienced a higher failure rate. Thirdly, a positive association was found between exam failure and personal distress and this effect was stronger for educational examinees compared to clinical examinees. The most intriguing discovery was that all biases, without exception, occurred among clinical psychologists, whereas educational psychologists displayed no biases. This outcome contrasted with initial expectations. Consequently, the present study aims to expand the existing knowledge about psychological biases and stereotypes by elucidate the reasons behind this discrepancy between the two disciplines while considering the advantages and disadvantages associated with a sense of "expertise" in the realm of adult diagnostics.

Selection and Recruitment Strategies among Competitive Pediatric Training Programs and the Impact of Diversity

OBJECTIVE

Aspects of the written application, interview and ranking may negatively impact recruitment of underrepresented in medicine (URiM) applicants. Our objectives were to explore knowledge, attitudes, and perceptions of pediatric faculty who assess potential trainees and how diversity impacts these assessments.

METHODS

We performed qualitative interviews of 20 geographically diverse faculty at large pediatric residencies and fellowships. We analyzed data using the constant comparative method to develop themes.

RESULTS

Four main themes emerged.

CONCLUSIONS

We describe ways in which bias infiltrates recruitment and strategies to promote diversity. Many strategies are variably implemented and the impact on workforce diversity in pediatric training programs remains unknown.

A Semistructured Interview for Surgical Residency Targeting Nontechnical Skills

OBJECTIVE

We review the development, implementation, and initial outcomes of a semistructured interview process to assess the nontechnical skills of surgical residency applicants.

DESIGN

In 2018, we restructured our residency selection interview process. Through semistructured faculty interviews, we sought to evaluate candidates along seven nontechnical skills (grit, ownership, rigor, teamwork, presence, impact, and organizational alignment). We plotted each candidate's scores on a radar plot for graphical representation and calculated the plot area of each candidate. We retrospectively evaluated 3 years of data, comparing the nontechnical skill scores of matriculants into the training program to those of nonmatriculants.

SETTING

Tenwek Hospital is a 361-bed tertiary teaching and referral hospital in rural western Kenya with a 5-year general surgery residency program.

PARTICIPANTS

Thirty-one applicants were interviewed over 3 years. Thirteen matriculated into the program.

RESULTS

Scores for grit, (4.8 vs 3.9; p = 0.0004), impact (4.2 vs 3.5; p = 0.014), ownership (4.2 vs 3.6; p = 0.01), and organizational alignment (4.3 vs 3.8; p = 0.008) were significantly higher in matriculants.

CONCLUSIONS

This semistructured interview process provides a robust and beneficial mechanism for assessing applicants' nontechnical skills, which may allow for the matriculation of more well-rounded candidates into surgical residency and, ultimately, surgical practice.

Simulation as Soothsayer: Simulated Surgical Skills MMIs During Residency Interviews are Associated With First Year Residency Performance

OBJECTIVE

The main consideration during residency recruitment is identifying applicants who will succeed during residency. However, few studies have identified applicant characteristics that are associated with competency development during residency, such as the Accreditation Council for Graduate Medical Education milestones. As mini multiple interviews (MMIs) can be used to assess various competencies, we aimed to determine if simulated surgical skills MMI scores during a general surgery residency interview were associated with Accreditation Council for Graduate Medical Education milestone ratings at the conclusion of intern year.

DESIGN

Retrospective cohort study. Interns' Step 1 and 2 clinical knowledge (CK) scores, interview day simulated surgical skills MMI overall score, traditional faculty interview scores, average overall milestone ratings in the spring of residency, and intern American Board of Surgery In-Training Examination (ABSITE) percentile scores were gathered. Two multiple linear regression were performed analyzing the association between Step 1, Step 2 CK, MMI, and traditional faculty interview scores with (1) average overall milestone rating and (2) ABSITE percentile scores, controlling for categorical/preliminary intern classification.

SETTING

One academic medical center PARTICIPANTS: General surgery interns matriculating in 2020-2021 RESULTS: Nineteen interns were included. Multiple linear regression revealed that higher overall simulated surgical skills MMI score was associated with higher average milestone ratings (β = .45, p = 0.03) and higher ABSITE score (β = .43, p = 0.02) while neither Step 1, Step 2 CK, nor faculty interview scores were significantly associated with average milestone ratings.

CONCLUSIONS

Surgical residency programs invest a tremendous amount of effort into training residents, thus metrics for predicting applicants that will succeed are needed. Higher scores on a simulated surgical skills MMIs are associated with higher milestone ratings 1 year into residency and higher intern ABSITE percentiles. These results indicate a noteworthy method, simulated surgical skills MMIs, as an additional metric that may select residents that will have early success in residency.

A Retrospective Analysis of Medical Student Performance Evaluations, 2014-2020: Recommend with Reservations

BACKGROUND

The Medical Student Performance Evaluations (MSPE) is a cornerstone of residency applications. Little is known regarding adherence to Association of American Medical Colleges (AAMC) MSPE recommendations and longitudinal changes in MSPE content.

OBJECTIVES

Evaluate current MSPE quality and longitudinal changes in MSPE and grading practices.

DESIGN

Retrospective analysis.

PARTICIPANTS

Students from all Liaison Committee on Medical Education (LCME)-accredited medical schools from which the Stanford University Internal Medicine residency program received applications between 2014-2015 and 2019-2020.

MAIN MEASURES

Inclusion of key words to describe applicant performance and metrics thereof, including distribution among students and key word assignment explanation; inclusion of clerkship grades, grade distributions, and grade composition; and evidence of grade inflation over time.

KEY RESULTS

MSPE comprehensiveness varied substantially among the 149 schools analyzed. In total, 25% of schools provided complete information consistent with AAMC recommendations regarding key word/categorization of medical students and clerkship grades in 2019-2020. Seventy-seven distinct key word terms appeared across the 139 schools examined in 2019-2020. Grading practices markedly varied, with 2-83% of students receiving the top internal medicine clerkship grade depending on the year and school. Individual schools frequently changed key word and grading practices, with 33% and 18% of schools starting and/or stopping use of key words and grades, respectively. Significant grade inflation occurred over the 6-year study period, with an average 14% relative increase in the proportion of students receiving top clerkship grades.

CONCLUSIONS

A minority of schools complies with AAMC MSPE guidelines, and MSPEs are inconsistent across time and schools. These practices may impair evaluation of students within and between schools.

Does Personality Matter? Perceptions and Experiences of Introverts and Extraverts as General Surgeons

PHENOMENON

Medical educators increasingly recognize both the challenges introverts, compared to extraverts, may face in medical training and the unique strengths they bring to practice. However, few researchers have examined in-depth how introverts and extraverts truly experience training and practice, particularly in specialties like surgery that tend to value qualities (e.g., dominance and assertiveness) typically associated with extraverts. This study aimed to explore the perceptions and experiences of individuals with both personalities within the field of general surgery.

APPROACH

Using a constructivist grounded theory approach, six general surgeons and 10 general surgery residents who identified as introverted, extraverted, or ambiverted were recruited from two Canadian tertiary care hospitals to participate in semi-structured interviews. Data collection and analysis occurred iteratively, and data were analyzed using open, selective, and thematic coding. Constant comparison allowed us to make sense of the similar and dissimilar views that emerged from each interview.

FINDINGS

Irrespective of their personalities, participants voiced two general patterns of responses. Some participants believed that "personality doesn't matter": that both introverted and extraverted practice styles were equally viable and neither introverts nor extraverts would find surgical training more challenging than the other (culture of equality). However, others believed that "personality matters," emphasizing that surgeons should be dominant and aggressive leaders. Only those who believed "personality matters" felt that introverts sometimes needed to act more extraverted in order to succeed in surgical training (culture of hierarchy). Similar numbers of introverts and extraverts adhered to each viewpoint.

INSIGHTS

Our qualitative approach allowed us to draw meaning from the complex subjective experiences of our research participants. Our findings suggest that two competing cultures (equality and hierarchy) co-exist within the field of surgery and that trainees, depending on which culture they adhere most to, will or will not "adapt" their personalities to the workplace. These findings deepen our understanding of the nuances of surgical culture and have important implications for how we select candidates based on personality.

Myers-Briggs Type Indicator Personality Types of Ophthalmology Residents

Objective This study attempts to use the Myers-Briggs Type Indicator (MBTI) to analyze personality types among current and recent ophthalmology residents. We aimed to evaluate the prevalence rates of each specific personality type in ophthalmology, and whether these changed by level of training, training program, or fellowship selection. The study aimed to evaluate whether certain personality types are more prevalent in ophthalmology as a unique medical specialty. This can help understand specialty choice and potentially predict trends in specialty selection.

Study Design After obtaining institutional review board approval from Howard University Hospital, an electronic version of the MBTI questionnaire, form M, was sent to participants. In addition to the questionnaire, participants responded to four questions inquiring about home program, postgraduate training level, subspecialty interest, and work environment (if applicable). The anonymous responses of the surveys were automatically scored on google forms, and the results were analyzed by using StatView statistical analysis.

Setting This study was conducted at Howard University, Georgetown University, George Washington University, University of Texas Medical Branch at Galveston, and Kresge Eye Institute.

Participants A total of 66 current residents and recent graduates of five residency programs were involved in this study.

Main Outcomes and Measures This study evaluated four-letter personality type from each participant.

Results Ophthalmology residents were statistically more likely to be identified in the categories of extroversion (E) than introversion (I) (p = 0.049), thinking (T) than feeling (F) (p = 0.027), and judging (J) than perceiving (P) (p = 0.007), with no statistically significant difference between sensing (S) and intuition (N). ENTP, ESTJ, and ISTJ were the most common personality types, each comprising 13.6% of the sample population. The ratio of J:P was found to increase as training level increased, beginning with postgraduate 2nd year until graduate level.

Conclusion Certain personality types are more common among ophthalmology residents in our cohort from five different training programs. It is possible that individual types change over the course of residency training and career. Understanding that these findings exist can be used as a baseline for future research in terms of potential predictors for applicants, of resident knowledge base, and personality changes over the course of one's training.

Systematic review of specialist selection methods with implications for diversity in the medical workforce

PURPOSE

There is growing concern that inequities in methods of selection into medical specialties reduce specialist cohort diversity, particularly where measures designed for another purpose are adapted for specialist selection, prioritising reliability over validity. This review examined how empirical measures affect the diversity of specialist selection. The goals were to summarise the groups for which evidence is available, evaluate evidence that measures prioritising reliability over validity contribute to under-representation, and identify novel measures or processes that address under-representation, in order to make recommendations on selection into medical specialties and research required to support diversity.

METHOD

In 2020-1, the authors implemented a comprehensive search strategy across 4 electronic databases (Medline, PsychINFO, Scopus, ERIC) covering years 2000-2020, supplemented with hand-search of key journals and reference lists from identified studies. Articles were screened using explicit inclusion and exclusion criteria designed to focus on empirical measures used in medical specialty selection decisions.

RESULTS

Thirty-five articles were included from 1344 retrieved from databases and hand-searches. In order of prevalence these papers addressed the under-representation of women (21/35), international medical graduates (10/35), and race/ethnicity (9/35). Apart from well-powered studies of selection into general practice training in the UK, the literature was exploratory, retrospective, and relied upon convenience samples with limited follow-up. There was preliminary evidence that bias in the measures used for selection into training might contribute to under-representation of some groups.

CONCLUSIONS

The review did not find convincing evidence that measures prioritising reliability drive under-representation of some groups in medical specialties, although this may be due to limited power analyses. In addition, the review did not identify novel specialist selection methods likely to improve diversity. Nevertheless, significant and divergent efforts are being made to promote the evolution of selection processes that draw on all the diverse qualities required for specialist practice serving diverse populations. More rigorous prospective research across different national frameworks will be needed to clarify whether eliminating or reducing the weighting of reliable pre-selection academic results in selection decisions will increase or decrease diversity, and whether drawing on a broader range of assessments can achieve both reliable and socially desirable outcomes.

Predictors of Success in an Orthopaedic Residency

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Orthopaedic surgery is one of the most competitive residencies to match into. Meanwhile, the average applicant's United States Medical Licensing Examination (USMLE) test scores, research involvement, and number of clinical honors increase every year.

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Measures such as USMLE scores, productivity in research, Alpha Omega Alpha (AΩA) honor society status, number of clinical honors, and performance on away rotations have all been cited as factors contributing to program directors choosing applicants for interviews and ranking them for their program. However, questions remain as to whether these measures translate to success on board examinations, high faculty evaluations, and designation as chief resident during orthopaedic residency.

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USMLE scores have been shown to correlate with Orthopaedic In-Training Examination (OITE) and American Board of Orthopaedic Surgery (ABOS) scores, while clinical grades and AΩA status correlate with faculty evaluations. Participating in research as a medical student was predictive of research productivity in residency but did not correlate with standardized testing scores or faculty evaluations.

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The literature has suggested ways in which measures such as personality and grit may be used in the application process and how these factors may contribute to predictors of success. However, additional research is needed to measure and define personality and grit during the application evaluation process.

The unique impact of COVID-19 on orthopedic surgery residency applicants and program directors in Canada

The COVID-19 pandemic led to the cancellation of visiting medical student electives and in-person residency interviews in Canada. Orthopedic surgery residency programs are now curtailed in their ability to self-promote and select optimal applicants. Online and social media tools should be adopted to promote programs. Faculty, residents and trainees should aim to attend virtual social and program information events. Applicants should make efforts to learn about the programs by attending events and reaching out to residents, and strengthen their application through research and other activities to demonstrate their interest and commitment to the field of orthopedic surgery. These efforts may help avoid the prospect of qualified candidates being unranked by programs or residency positions being unfilled. These difficult circumstances may serve to engender collaboration and cooperation across residency programs and medical schools and lay the foundation for a thriving interconnected ecosystem of future orthopedic surgeons.

Interviewing in the Wake of COVID-19: How Orthopaedic Residencies, Fellowships, and Applicants Should Prepare for Virtual Interviews

On May 7, 2020, the Coalition for Physician Accountability's released "Medical Students in the Class of 2021: Moving Across Institutions for Post Graduate Training," which comprises official recommendations on keeping programs and medical students safe during the upcoming match cycle with the challenges posed by COVID-19. In these recommendations, away rotations are discouraged, and all programs are compelled to commit to virtual interviews. Unlike employers and applicants in other industries, orthopaedic residency/fellowship programs and candidates seeking those positions have not routinely conducted virtual interviews. Without in-person interviews, applicants may perceive a limited ability to demonstrate their qualifications, judge program culture, and gauge ultimate program compatibility. Likewise, programs may perceive the inability to evaluate a candidate in real time, physically show program strengths, and ultimately judge applicant compatibility. Careful preparation and execution of a virtual interview can overcome these perceived limitations, whereas benefits, such as decreased cost for both programs and applicants, can make virtual interviews appealing. The purpose of this review was to help define a virtual interview, illustrate the benefits, and offer tips to both programs and applicants on how to prepare and perform optimally on an interview day.

A Systematic Review of the Abdominal Surgeon's Personality: Exploring Common Traits in Western Populations

The personality traits commonly seen in abdominal surgeons remains undefined, and its potential influence on decision-making and patient outcomes underexplored. This systematic review identified studies on abdominal surgeons who had undergone validated personality testing, with assessment of decision-making and post-operative patient outcomes. The study protocol was registered on PROSPERO (University of York, UK (CRD42019151375)). MEDLINE, Embase, PsycInfo and Cochrane Library databases were searched using the keywords: surgeon; surgeon personality; outcomes. All study designs were accepted including adult visceral surgeons published in English. Five articles from 3056 abstracts met our inclusion criteria and one article was identified from hand searches with two reviewers screening studies. Bias was assessed using the Newcastle-Ottawa scale. Six studies included 386 surgeons. Studies assessing personality using the Five Factor Model (four studies, 329 surgeons) demonstrated higher levels of conscientiousness (self-discipline, thoughtfulness), extraversion (sociability, emotional expression) and openness (creative, conventional) in surgeons versus population norms. Surgeon characterisation of agreeableness and emotional stability was less clear, with studies reporting mixed results. Post-operative outcomes were reported by only one study. Further exploration of the influence of surgeon personality and its influence on decision-making is necessary to deliver patient-centred care and targeted non-technical skills training for surgeons.

A scoping review of admission criteria and selection methods in nursing education

BACKGROUND

Nursing education institutions are required to select and train applicants who have appropriate characteristics for delivering effective healthcare. Unlike other healthcare professions and despite the need to attract and select a competent workforce, there has been no comprehensive analysis of the selection criteria and methods used to recruit nursing students. As there is relatively limited prior research available, we conducted a scoping review to explore and synthesise the existing evidence regarding admission criteria and selection methods of nursing students and for the purpose of identifying an agenda for future research in this field.

METHODS

Our scoping review follows the Arksey and O'Malley five-step proposition including identifying the research question and relevant studies, study selection, tabulation of data, and summarizing and reporting the results. Seven databases (PubMed, CINAHL, Scopus, ERIC, SID, Irandoc and PsycINFO) were searched systematically using relevant keywords. Articles on admission of undergraduate nursing students published in both English and/or Persian from 2006 to 2019 were retrieved.

RESULTS

Existing research evidence suggests that nursing students are largely selected on the basis of two criteria - "cognitive-academic abilities" and "non-cognitive abilities." Cognitive-academic abilities were assessed in four main dimensions of mathematics, language, natural sciences and reasoning skills mainly through standardized tests and academic records. Our review shows a wide range of non-cognitive characteristics are evaluated in nursing applicants including: morality, interpersonal communication skills and psychological strength. The selection method most commonly used to assess characteristics was through interviews (panel interviews or multiple mini interviews). Other methods included references, personal statements and personality assessment tools.

CONCLUSIONS

This is the first scoping review of literature regarding nursing education selection and recruitment. Results can be used to inform nursing education policymakers and institutions in the design of their selection practices. Future research should concentrate on the evaluation and improvement methods of student selection including content and predictive validity analysis of multiple mini interview and standardized tests, development of cost-effective selection methods and job analysis studies to identify specific non-cognitive characteristics for nursing.

The role of the interview in residency selection: A mixed-methods study

CONTEXT

Residency programmes invest considerable time and resources in candidate interviews as a result of their perceived ability to reveal important social traits. However, studies examining the ability of interviews to predict resident performance have shown mixed findings, and the role of the interview in candidate evaluation remains unclear. This mixed-methods study, conducted in an anaesthesiology residency programme at a large academic medical centre, examined how interviews contributed to candidate assessment and whether the addition of behavioural questions to interviews altered their role in the evaluation process.

METHODS

During the 2018-2019 residency selection season in the Department of Anesthesiology and Critical Care at the University of Pennsylvania, independent ratings for each interviewee were collected from faculty interviewers. Consensus ratings subsequently established by committee were also collected. Committee meetings were audiorecorded and transcribed for qualitative analysis. Behavioural questions were integrated into half of interview days. Ratings of candidates interviewed on behavioural question days were compared statistically with those of candidates interviewed on non-behavioural question days.

RESULTS

Qualitative analysis showed that interviewers heavily emphasised candidates' application files in evaluating the interviews. Interviewers focused on candidates' academic records and favoured candidates whose interview behaviours were consistent with their applications and whose applications demonstrated similarities to interviewers' traits. The addition of behavioural questions demonstrated little ability to alter these dynamics. Quantitatively, there were no significant differences in candidate rating outcomes between behavioural and non-behavioural interviewing days, whereas a higher medical school rating and higher score on the United States Medical Licensing Examination Step 1 were associated with a more favourable consensus rating.

CONCLUSIONS

Residency candidates' application files predisposed interviewers' experience and evaluation of interviews, preventing the interviews from providing discrete assessments of interpersonal qualities, even when behavioural questions were included. In the continued effort to perform well-rounded assessments of residency candidates, further research and reflection on the role of interviewing in evaluation are necessary.

Values and beliefs on trainee selection: What counts in the eye of the selector? A qualitative study exploring the program director's perspective

OBJECTIVES

Postgraduate trainee selection is a high-stakes process. While many studies focused on selection methods and psychometrics, little is known about the influence of selectors' personal values and beliefs in the judgment and decision-making process. A better understanding of these factors is vital since selectors determine the future workforce.

METHODS

We interviewed programme directors (PDs) from 11 specialties in one University Hospital. Thematic analysis was conducted with a combined approach of generic and in-vivo coding.

RESULTS

PDs value excellence, 'fit' and personal characteristics. The content of these values are subject to personal interpretation and differ between PDs. PDs use various 'proxies' as alternative indicators of performance. They consider intuition, teamwork and autonomy important in judgement and decision-making. PDs find selection challenging and feel great accountability towards candidates and society.

CONCLUSIONS

Selectors criteria of judgement- and decision-making often remain implicit and focus on prior achievements and 'fit' with the current trainee-pool, possibly compromising the workforce's diversity. Implicit 'proxies' and intuitive decision-making may be an unwitting source of judgemental bias. 'Making the implicit explicit', by increasing awareness of personal values and beliefs and structuring the selection interview, may improve the quality of trainee selection.

Selection of New Psychiatry Residents Within a National Program: a Qualitative Study of Faculty Perspectives on Competencies and Attributes

OBJECTIVE

Admission committees use multiple sources of information to select residents. However, the way in which faculty members use each data source remains unclear and highly context-specific. The present study seeks to understand how faculty members use various sources of information about candidates to make admission decisions to a National Psychiatry Residency Program.

METHODS

The theory of core competencies was used as a foundation for this qualitative study. Framework analysis was used to structure the project and data presentation. Twenty key informants from the faculty were purposefully sampled in accordance with the initial theory. Open-ended semi-structured interviews were conducted to obtain their views about the essential competencies of psychiatrists and the ways in which these competencies could be reliably gauged.

RESULTS

Participants described numerous competencies that they believed were essential to becoming competent psychiatrists. These competencies fell within the six core competencies of the Accreditation Council for Graduate Medical Education framework. However, several non-competency attributes (such as perseverance, empathy, and compassion) were also relevant in the selection process. To reduce the impact of self-presentation bias, to which these attributes were vulnerable, the faculty relied heavily on sources of information obtained from third parties, such as feedback from co-workers with first-hand experience of the candidate during their clinical placements.

CONCLUSION

Faculty members place importance on informal informant-derived information about a candidate's non-competency attributes in addition to core competencies when deciding whether or not to select a candidate for admission into a residency training program.

Personality Assessment and Emotional Intelligence in Orthopaedic Surgery Residency Selection and Training

Orthopaedic surgery has increasingly emerged as one of the most popular and competitive of all medical specialties. The selection of the best applicants has become a more difficult process because the number of qualified medical students has concomitantly grown. Although there are standardized guidelines in residency selection, there are several intangible factors that determine an applicant's fit into a program. Personality assessments, such as the Neuroticism-Extraversion-Openness Personality Inventory and the Myers-Briggs Type Indicator, are proficiencies that have garnered significant interest to help fill this void. Understanding and measuring empirically supported measures of personality traits and styles of medical students and residents may be valuable to medical educators and program directors in a variety of applications such as residency selection, mentoring, and education. Similar to personality identification, emotional intelligence assessments, such as the Mayer-Salovey-Caruso Emotional Intelligence Test, can prove to be pivotal tools in residency education and training. Emotional intelligence has shown to align with current Accreditation Council for Graduate Medical Education residency standardized core competencies that emphasize aptitude in noncognitive characteristics.

A comparison of temperament and character among psychiatry, internal medicine, and surgery residents at Iran University of Medical Sciences in the academic year 2013-2014

Background: This study was conducted to compare temperament and character among psychiatry residents, internal medicine, and surgery residents in hospitals affiliated to Iran University of Medical Sciences in the academic year 2013-2014. Methods: This cross sectional analytical study was conducted on 201 residents using the non-probability method of convenience sampling. Cloninger's 125-item Temperament and Character Inventory (TCI) and Maslach's Burnout Inventory (MBI) were distributed among all the residents in their morning session. Once the questionnaires were completed and submitted, the data were analyzed in SPSS 16. The frequency of different personality traits was analyzed among the selected residents. Results: A total of 49.8% of the respondents were female (n=100) and 50.2% were male (n=101). The results of data analysis showed more novelty seeking, reward dependence, and harm avoidance and less persistence (33.93, p=0.006; 9.00, p=0.056; 32.55, p=0.021; and 2.48, p=0.028, respectively) in psychiatry residents than in surgery residents (31.97, 7.87, 30.74, and 3.12 respectively). Reward dependence was more frequent in internal medicine residents than in surgery residents (9.44 and 7.87 respectively, p=0.002). The self-directedness score was lower in psychiatry residents than in internal medicine residents (p=0.761) and higher than in surgery residents (17.96, 18.30, and 17.57 respectively, p=0.824). The cooperativeness and self-transcendence scores were higher in psychiatry residents than in internal medicine (p=0.943, p=0.199, respectively) and surgery residents (p=0.105, p=0.069 respectively). Conclusion: The different dimensions of personality varied between the surgery, internal medicine, and psychiatry residents. Particularly, this study did not show statistically significant differences in dimensions of character (cooperativeness, self-directedness, and self-transcendence) among surgery, internal medicine, and psychiatry residents. The selection of medical specialties based on character traits significantly contributes to more effective treatment of patients and higher satisfaction of the residents.

Diversity in Orthopaedic Surgery: International Perspectives: AOA Critical Issues

Orthopaedic surgery in the United States is one of the few medical specialties that has consistently lacked diversity in its training programs and workforce for decades, despite increasing awareness of this issue. Is this the case in other English-language speaking countries? Are there inherent national differences, or does orthopaedics as a profession dictate the diversity landscape around the globe?The Carousel group includes the presidents of the major English-language-speaking orthopaedic organizations around the globe-Australia, Canada, New Zealand, South Africa, the United Kingdom, and the United States. Established in 1952, members of this group attend each other's annual scientific meetings during the year of their presidency, learning about our profession in each country and building international relationships. In this article, 13 Carousel presidents from different countries explore diversity in orthopaedics in their training programs and the workforce, with an assessment of the current state and ideas for improvement.

Selecting Residents for Predetermined Factors Identified and Thought to be Important for Work Performance and Satisfaction: A Methodology

OBJECTIVE

The medical profession seeks to hire and train individuals who consistently meet and/or exceed both job and cultural expectations. Resident selection is often not structured to meet this goal. The objective of this quality improvement project was to evaluate a classic unscripted interview process (OI) in conjunction with a structured, scripted interview process (SI) developed using an established hiring methodology from industry not yet utilized in health care. Qualitative questions we sought to answer: (1) Can SI be practically applied to the selection of residents? (2) Is there a significant difference in the relative position of applicants between the OI and SI rank lists? (3) Qualitatively, does SI help the evaluation/discussion of the affective domain?

METHODS

Design: Prospective qualitative comparison of OI versus SI.

SETTING

Dartmouth Hitchcock Medical Center, Lebanon, NH.

PARTICIPANTS

Applicants were assessed by OI and SI. SI factors were selected based on a job profile. Interview scripts were created from validated behavioral and attitudinal questions. Online assessments assessed 2 important attributes - adaptability and values. Rank lists were compared for relative rank position of applicants. Feedback from faculty was obtained.

RESULTS

Fifty-two applicants. Critical attributes were self-management, integrator-synthesizer, versatility, communication, and achievement. Absolute mean difference in rank/applicant was 9.8 (standard deviation 8.9, Range 0-36) positions. Comparing the top 20 candidates of each rank list, 40% of those applicants were only on one list. Faculty felt that applicants were given a greater opportunity to show "who they are."

CONCLUSIONS

In conjunction with OI, an industry proven methodology was practically applied to define and select for high performance for the authors' specific institution. Comparing OI and SI resulted in substantial differences in rank lists. This initiative seemed to provide a structure to evaluate values and motivations that are inherently difficult to assess. Faculty felt SI in conjunction with OI gave a greater chance for applicants to show "who they are."

Interview Techniques Utilized in Radiology Resident Selection-A Survey of the APDR

RATIONALE AND OBJECTIVES

To evaluate interview techniques currently used in the selection of diagnostic radiology resident candidates and to identify factors influencing the use of alternative interview techniques.

MATERIALS AND METHODS

An anonymous 25 question e-mail survey was provided to 319 active members of the Association of Program Directors in Radiology. The survey included questions on residency demographics, organization of resident applicant interviews, types of interview techniques utilized, scoring and ranking of applicants, and facets of the interview/application felt most important to the selection process. Statistical analysis was performed to identify factors associated with the use of alternative interview techniques.

RESULTS

93.7% of responding programs use traditional interview techniques, with 92% using unblinded, unstructured interviews, 8% blinded, unstructured interviews. Structured interview questions were incorporated in 22%. Few programs used alternative techniques like the multiple mini-interview. None of the programs used written prompts during the interview, 3% used casual visual cognitive testing, 10% used panel interview techniques, and none used formal personality testing. For ranking candidates in the match, the most important facets considered were USMLE Step scores, performance on the interview, clinical course grades, and letters of reference. Factors associated with use of alternative techniques were domains associated with program size and number of faculty.

CONCLUSION

The majority of radiology training programs still rely upon the traditional unblinded interview technique. There is an opportunity for training programs to examine alternative techniques that reduce bias and may provide better insight into other aspects of the candidate that may not be as readily highlighted with the traditional, unblinded interview.

Multiple Mini-interview Consistency and Satisfactoriness for Residency Program Recruitment: Oman Evidence

Objectives

Standard interviews are used by most residency programs to assess non-cognitive skills, but variability in the interviewer’s skills, interviewer bias, and context specificity limit reliability. We sought to investigate the consistency and satisfactoriness of the multiple mini-interview (MMI) model for resident selection into an otorhinolaryngology head and neck surgery residency program.

Methods

This pilot study was done in an independent academic residency training center for 15 applicants, in seven eight-minute MMI stations with eight raters for the 2015–2016 academic year. The raters included the chief resident and education committee chairman in one of the stations. Candidates were assessed on two items: medical knowledge (two standardized case scenarios) and behavioral knowledge (personality and attitude, professionalism, communication, enthusiasm to the specialty, and English proficiency).

Results

Of 15 candidates, 10 (66.7%) were female and five (33.3%) were male; five were recommended for selection, and five were kept on the waiting list. The reliability, intraclass correlation coefficient (ICC), of the scores obtained from seven items of MMI was 0.36 (95% confidence interval (CI): -0.31–0.75; p = 0.110). However, the ICC of the medical interview was 0.54 (95% CI: 0.45–0.84; p = 0.090). The correlation between behavioral items score and MMI total score was r = 0.135 (p = 0.150).

Conclusions

The interview evaluation/survey form given to candidates and interviewers has shown that MMI is a fair and effective tool to evaluate non-cognitive traits. Both candidates and interviewers prefer MMI to standard interviews. The MMI process for residency interviews can generate reliable interview results using only seven stations and is acceptable and preferred over standard interview modalities by residency program applicants and faculty members.

Assessing noncognitive domains of respiratory therapy applicants: Messick's framework appraisal of the multiple mini-interview

Educators who assess incoming applicants into a health professional training program are looking for a wide array of cognitive and noncognitive skills that best predict success in the program and as a future practicing professional. While aptitude tests generally measure cognitive skills, noncognitive constructs are more difficult to measure appropriately. The traditional method of measuring noncognitive constructs has been the panel interview. Panel interviews have been described as inconsistent in measuring noncognitive domains and consistently reported as unreliable and susceptible to bias. An alternate interview method used in many health professions schools is the multiple mini-interview (MMI) that was specifically designed to assess noncognitive domains in health professions education. This paper discusses the purpose of using the MMI, how the MMI is conducted, specific domains of focus for the MMI, and the feasibility of creating an MMI. Finally, the paper uses Messick's framework on validity to guide the consideration of the MMI.

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

OBJECTIVE

To determine if any of the unique elements of the applications of medical students who were granted interviews to an orthopedic residency program correlate to the program's final rank order list of candidate residents.

DESIGN

Eight domains of the standard residency application were considered as independent variables for 36 applicants. Personal, identifying information was removed from the application material within each domain, thus blinding the application domains for 5 core faculty members from the program to review and rank independently. These 8 domain rank lists were then compared to the program's final rank list order to determine the correlation of each domain with the final rank list order.

SETTING

Academic medical center.

PARTICIPANTS

Applicants to a university-based orthopedic surgery residency program who were granted interviews in the 2016 academic year.

RESULTS

Two domains of the application correlated with the final rank list order: interview and personal statement. None of the other domains had a significant correlation with the final rank list order. Interobserver variability among the faculty members was high for the rankings of the different domains.

CONCLUSIONS

Interview and personal statement were the only domains within the application that had correlation with the final rank list for an orthopedic residency program. A better understanding of how these 2 components affect the rank list may provide opportunity for process improvements.

Use of a Novel Measure of Nontechnical Skills in Surgical Trainees: Is There an Association With Technical Skills Performance?

OBJECTIVE

To investigate whether scores on a psychological measure of concentration and interpersonal characteristics, The Attentional and Interpersonal Style Inventory (TAIS), are associated with performance of surgical skills.

DESIGN

Postgraduate surgical trainees completed an operative surgical skills assessment in the simulation laboratory and the psychological measure (TAIS). The surgical skills assessment consisted of 6 tasks (3 per trainee): laceration suturing; lipoma excision; incision and closure of a laparotomy wound; bowel anastomosis; saphenofemoral junction ligation and basic laparoscopic skills. The association between operative surgical skill performance and TAIS factors was investigated.

SETTING

The TAIS assessments and surgical skills assessments were conducted at the National Surgical Training Centre at the Royal College of Surgeons in Ireland (RCSI).

PARTICIPANTS

One hundred and two surgical trainees in years one and two (PGY 2-3 equivalent) participated in the study.

RESULTS

Performance on 2 of the 6 tasks assessed (bowel anastomosis and lipoma excision) were positively associated with multiple TAIS factors (energy, confidence, competitiveness, extroversion, self-criticism and performing under pressure). Another factor, focus over time, was significantly associated with scores on the lipoma excision task.

CONCLUSIONS

Trainees with high levels of energy, confidence, competitiveness, extroversion, and focus over time and low levels of self-criticism demonstrated better performance on specific technical skills tasks.

Personality Assessment in Orthopaedic Surgery: AOA Critical Issues

Personality assessment tools are used effectively in many arenas of business, but they have not been embraced by the medical profession. There is increasing evidence that these tools have promise for helping to match resident candidates to specific fields of medicine, for mentoring residents, and for developing improved leadership in our field. This paper reviews many aspects of personality assessment tools and their use in orthopaedic surgery.

Non-cognitive factors predicting success in orthopedic surgery residency

Admissions to orthopedic surgery is a highly competitive process. Traditionally measures such as United States Medical Licensing Examination (USMLE) Step 1, class rank, AOA status have been major determinants in the ranking process. However, these traditional objective measures show mixed correlation to clinical success in orthopedic surgery residency. There have been several studies on the cognitive factors and their correlation with success in residency. However, it is clear that residency requires more than objective cognition, emphasizing complex social interactions that are influenced by non-cognitive variables including personality, work ethic, etc. This review aims to summarize the current understanding of non-cognitive factors influencing performance in orthopaedic surgical residency.

The Orthopaedic Surgery Residency Application Process: An Analysis of the Applicant Experience

INTRODUCTION

Orthopaedic surgery residency positions are highly sought after. The purpose of this survey study was to report the following components of the applicant experience: (1) the number of programs to which applicants applied and interviewed, (2) the performance criteria associated with receiving interviews, (3) the way applicants respond to e-mail interview offers, (4) the pre- and post-interview communication between applicants and programs, (5) the importance of interview day activities and the determinants of the applicant rank order list (ROL), and (6) the financial cost of the application process.

METHODS

An online survey was administered and entirely completed by a representative sample of 100 orthopaedic surgery residency applicants for the 2015 to 2016 cycle during the 3-week period between the last interview of the application season and the deadline for ROL certification. The survey included 45 questions: 7 for background, 7 for competitiveness, 15 for the interaction between applicants and programs, 15 for the importance of interview day experience and the determinants of the applicant ROL, and 1 for the cost of attending each interview.

RESULTS

Students applied to 83 ± 27 programs, received 17 ± 10 interviews, and attended 12 ± 5 interviews. Interview offers correlated with, in descending order, Alpha Omega Alpha status, Step 2 Clinical Knowledge, and Step 1. The mean time to reply of interview offer was 17 minutes, yet 25% of the applicants lost at least one interview despite having at least one other person monitor the applicant's e-mail account. Applicants and programs frequently contacted each other to express interest. Although evaluating current residents was the most valuable aspect of interview day to applicants, the strongest determinants for applicants' ROLs were location and surgical experience, with research the least important factor. The cost of interview season was >$7,000 per applicant, excluding away externships.

CONCLUSION

Applying to orthopaedic surgery residency is a complex, competitive, and costly experience for applicants. The application process may benefit from better expectation management of applicant candidacy and a more prohibitive communication policy between applicants and programs after the interview day.

The Role of Mentoring in the Development of Successful Orthopaedic Surgeons

Mentoring plays an integral role in orthopaedic surgeons' career development and personal growth. Effective mentors are committed to their roles, provide skilled instructional support, model continuous learning, and communicate optimism. Numerous obstacles impede productive mentoring relationships in medicine, including reluctance to ask for help, time constraints due to extensive work obligations, lack of institutional support, relational difficulties, and lack of mentoring skills. Effective partnerships require a concerted effort to establish behaviors conducive to mentoring, such as sharing knowledge and providing constructive feedback. Given that women represent only 13% of orthopaedic surgery residents and racial/ethnic minorities account for 3% to 10% of US orthopaedic surgeons, mentoring may help diversify the workforce by providing early exposure and professional support to physicians from underrepresented demographic groups. Orthopaedic leaders must embrace their professional obligation to cultivate and inspire the next generation of orthopaedic surgeons.

Personality Assessment for Employee Development: Ivory Tower or Real World?

The acceptance and popularity of personality assessments in organizational contexts has grown enormously over the last 40 years. Although these are used across many applications, such as executive coaching, team building, and hiring and promotion decisions, the focus of most published research on the use of personality assessments at work is biased toward assessment for employee selection. Reviews have therefore tended to use criteria that are appropriate for selection, neglecting the additional and different criteria that are important in relation to employee development. An illustration of the often-discussed scientist-practitioner divide is that the Myers-Briggs Type Indicator is the most widely known and used personality assessment in organizations, despite harsh criticism by the academic community. This article reviews this debate, and draws implications for the appropriate choice of personality assessments for use in individual and team development, and a new direction for scientific research.

Experiences of pressure to conform in postgraduate medical education

BACKGROUND

Perception of pressure to conform prevents learners from actively participating in educational encounters. We expected that residents would report experiencing different amounts of pressure to conform in a variety of educational settings.

METHODS

A total of 166 residents completed questionnaires about the frequency of conformity pressure they experience across 14 teaching and clinical settings. We examined many individual characteristics such as their age, sex, international student status, level of education, and tolerance of ambiguity; and situational characteristics such as residency program, type of learning session, status of group members, and type of rotation to determine when conformity pressure is most likely to occur.

RESULTS

The majority of participants (89.8%) reported pressure to conform at least sometimes in at least one educational or clinical setting. Residents reported higher rates of conformity during informal, rather than formal, teaching sessions, p < .001. Also, pressure was greater when residents interacted with higher status group members, but not with the same or lower level status members, p < .001. Effect sizes were in the moderate range.

CONCLUSIONS

The findings suggest that most residents do report feeling pressure to conform in their residency settings. This result is consistent with observations of medical students, nursing students, and clerks conforming in response to inaccurate information within experimental studies. Perception of pressure is associated with the setting rather than the trainee personal characteristics.

Utility of selection methods for specialist medical training: A BEME (best evidence medical education) systematic review: BEME guide no. 45

BACKGROUND

Selection into specialty training is a high-stakes and resource-intensive process. While substantial literature exists on selection into medical schools, and there are individual studies in postgraduate settings, there seems to be paucity of evidence concerning selection systems and the utility of selection tools in postgraduate training environments.

AIM

To explore, analyze and synthesize the evidence related to selection into postgraduate medical specialty training.

METHOD

Core bibliographic databases including PubMed; Ovid Medline; Embase, CINAHL; ERIC and PsycINFO were searched, and a total of 2640 abstracts were retrieved. After removing duplicates and screening against the inclusion criteria, 202 full papers were coded, of which 116 were included.

RESULTS

Gaps in underlying selection frameworks were illuminated. Frameworks defined by locally derived selection criteria, and heavily weighed on academic parameters seem to be giving way to the evidencing of competency-based selection approaches in some settings. Regarding selection tools, we found favorable psychometric evidence for multiple mini-interviews, situational judgment tests and clinical problem-solving tests, although the bulk of evidence was mostly limited to the United Kingdom. The evidence around the robustness of curriculum vitae, letters of recommendation and personal statements was equivocal. The findings on the predictors of past performance were limited to academic criteria with paucity of long-term evaluations. The evidence around nonacademic criteria was inadequate to make an informed judgment.

CONCLUSIONS

While much has been gained in understanding the utility of individual selection methods, though the evidence around many of them is equivocal, the underlying theoretical and conceptual frameworks for designing holistic and equitable selection systems are yet to be developed.

Factors Motivating Medical Students in Selecting a Career Specialty: Relevance for a Robust Orthopaedic Pipeline

INTRODUCTION

Selection of a career specialty by medical students is a complex and individualized decision. Our goals were to understand the factors that influenced medical students in selecting their career specialty, identify the stage at which this decision was made, and understand the role of demographics, mentors, and curricula in this process.

METHODS

Medical students from 10 institutions participated in a web-based survey. Results were stratified by sex, race/ethnicity, and level of interest in orthopaedic surgery.

RESULTS

A total of 657 students responded to the survey. Specialty content (mean rating, 8.4/10) and quality of life/lifestyle/stress level (7.5/10) were the primary motivating factors in selecting a specialty. Interest in orthopaedic surgery was lower in women than in men (2.7 versus 3.9; P < 0.01) and was equivalent among race/ethnicity groups. Although 27% of students reported moderate or extensive medical school curriculum exposure to orthopaedics, this education did not sway them toward the specialty.

CONCLUSIONS

Levels of interest in orthopaedics among medical students may be lower than generally assumed. Increasing the attractiveness of the specialty will require a multifaceted approach, including recognition of lifestyle factors, adjustments in the orthopaedic clerkship to make the specialty more appealing, mentorship by orthopaedic faculty, and conversion of high levels of interest in the specialty among minority medical students into successful residency applications.

LEVEL OF EVIDENCE

IV.

A Comparison of Matched and Unmatched Orthopaedic Surgery Residency Applicants from 2006 to 2014: Data from the National Resident Matching Program

BACKGROUND

The Association of American Medical Colleges publishes residency match data and reports through the National Resident Matching Program (NRMP) every year. The purpose of this study was to analyze trends in orthopaedic surgery residency matching data and characteristics of successful applicants to counsel medical students with regard to their chances of matching.

METHODS

The annual reports of the NRMP were searched annually from 2006 to 2014 to determine the number of orthopaedic surgery residency positions available, the number of applicants, and the match rate among applicants. Comparisons were performed between matched applicants and unmatched applicants with regard to the number of contiguous ranks and distinct specialties, United States Medical Licensing Examination (USMLE) scores, number of research experiences and research products (abstracts, presentations, posters, publications), and proportion of Alpha Omega Alpha (AOA) Honor Medical Society members and students at a top-40, National Institutes of Health (NIH)-funded medical school.

RESULTS

The number of orthopaedic surgery positions available and number of applicants increased at a mean rate of 9 positions and 65 applicants per year (p = 0.11). The mean number of contiguous ranks for U.S. senior medical students was 11.5 for those who matched and 5.5 for those who did not match (p < 0.0001). The USMLE scores for applicants who matched were significantly greater than for those who did not match in each category: Step-1 scores for U.S. seniors (p < 0.001) and independent applicants (p = 0.039), and Step-2 scores for U.S. seniors (p < 0.01) and independent applicants (p = 0.026). The mean number of research products was significantly greater for matched U.S. seniors compared with unmatched U.S. seniors (p = 0.035). A significantly higher proportion of matched U.S. seniors compared with unmatched U.S. seniors were AOA members and students at a top-40, NIH-funded medical school (both p < 0.0001).

CONCLUSIONS

Successful applicants in the Match for orthopaedic surgery residency have higher USMLE Step-1 and 2 scores, number of research experiences and research products, and contiguous ranks. A higher proportion of successful applicants are AOA members and students at a top-40, NIH-funded medical school.

Selection for Surgical Training: An Evidence-Based Review

PURPOSE

The predictive relationship between candidate selection criteria for surgical training programs and future performance during and at the completion of training has been investigated for several surgical specialties, however there is no interspecialty agreement regarding which selection criteria should be used. Better understanding the predictive reliability between factors at selection and future performance may help to optimize the process and lead to greater standardization of the surgical selection process.

METHODS

PubMed and Ovid MEDLINE databases were searched. Over 560 potentially relevant publications were identified using the search strategy and screened using the Cochrane Collaboration Data Extraction and Assessment Template.

RESULTS

57 studies met the inclusion criteria. Several selection criteria used in the traditional selection demonstrated inconsistent correlation with subsequent performance during and at the end of surgical training. The following selection criteria, however, demonstrated good predictive relationships with subsequent resident performance: USMLE examination scores, Letters of Recommendation (LOR) including the Medical Student Performance Evaluation (MSPE), academic performance during clinical clerkships, the interview process, displaying excellence in extracurricular activities, and the use of unadjusted rank lists.

CONCLUSIONS

This systematic review supports that the current selection process needs to be further evaluated and improved. Multicenter studies using standardized outcome measures of success are now required to improve the reliability of the selection process to select the best trainees.

Student nurse selection and predictability of academic success: The Multiple Mini Interview project

BACKGROUND

With recent reports of public enquiries into failure to care, universities are under pressure to ensure that candidates selected for undergraduate nursing programmes demonstrate academic potential as well as characteristics and values such as compassion, empathy and integrity. The Multiple Mini Interview (MMI) was used in one university as a way of ensuring that candidates had the appropriate numeracy and literacy skills as well as a range of communication, empathy, decision-making and problem-solving skills as well as ethical insights and integrity, initiative and team-work.

OBJECTIVES

To ascertain whether there is evidence of bias in MMIs (gender, age, nationality and location of secondary education) and to determine the extent to which the MMI is predictive of academic success in nursing.

DESIGN

A longitudinal retrospective analysis of student demographics, MMI data and the assessment marks for years 1, 2 and 3.

SETTINGS

One university in southwest London.

PARTICIPANTS

One cohort of students who commenced their programme in September 2011, including students in all four fields of nursing (adult, child, mental health and learning disability).

METHODS

Inferential statistics and a Bayesian Multilevel Model.

RESULTS

MMI in conjunction with MMI numeracy test and MMI literacy test shows little or no bias in terms of ages, gender, nationality or location of secondary school education. Although MMI in conjunction with numeracy and literacy testing is predictive of academic success, it is only weakly predictive.

CONCLUSIONS

The MMI used in conjunction with literacy and numeracy testing appears to be a successful technique for selecting candidates for nursing. However, other selection methods such as psychological profiling or testing of emotional intelligence may add to the extent to which selection methods are predictive of academic success on nursing.

Correlation of personality assessments with standard selection criteria for neurosurgical residency applicants

OBJECTIVE Neurosurgery is among the most competitive residencies, as evidenced by the high number of applicants for relatively few positions. Although it is important to recruit candidates who have the intellectual capacity and drive to succeed, traditional objective selection criteria, such as US Medical Licensing Examination (USMLE) (also known as Step 1) score, number of publications, and class ranking, have not been shown to consistently predict clinical and academic success. Furthermore, these traditional objective parameters have not been associated with specific personality traits. METHODS The authors sought to determine the efficacy of a personality assessment in the selection of neurosurgery residents. Specifically, the aim was to determine the correlation between traditional measures used to evaluate an applicant (e.g., USMLE score, number of publications, MD/PhD status) and corresponding validated personality traits. RESULTS Fifty-four neurosurgery residency applicants were interviewed at the Cleveland Clinic during the 2014-2015 application cycle. No differences in validated personality scores were identified between the 46 MD applicants and 8 MD/PhD applicants. The mean USMLE score (± SD) was 252.3 ± 11.9, and those in the high-USMLE-score category (USMLE score ≥ 260) had a significantly lower "imaginative" score (a stress measure of eccentric thinking and impatience with those who think more slowly). The average number of publications per applicant was 8.6 ± 7.9, and there was a significant positive correlation (r = 0.339, p = 0.016) between greater number of publications and a higher "adjustment" score (a measure of being even-tempered, having composure under pressure). Significant negative correlations existed between the total number of publications and the "excitable" score (a measure of being emotionally volatile) (r = -0.299, p = 0.035) as well as the "skeptical" score (measure of being sensitive to criticism) (r = -0.325, p = 0.021). The average medical school rank was 25.8, and medical school rankings were positively correlated with the "imaginative" score (r = 0.287, p = 0.044). CONCLUSIONS This is the first study to investigate the use of personality scores in the selection of neurosurgical residents. The use of personality assessments has the potential to provide insight into an applicant's future behavior as a resident and beyond. This information may be useful in the selection of neurosurgical residents and can be further used to customize the teaching of residents and for enabling them to recognize their own strengths and weaknesses for self-improvement.

How effective are selection methods in medical education? A systematic review

CONTEXT

Selection methods used by medical schools should reliably identify whether candidates are likely to be successful in medical training and ultimately become competent clinicians. However, there is little consensus regarding methods that reliably evaluate non-academic attributes, and longitudinal studies examining predictors of success after qualification are insufficient. This systematic review synthesises the extant research evidence on the relative strengths of various selection methods. We offer a research agenda and identify key considerations to inform policy and practice in the next 50 years.

METHODS

A formalised literature search was conducted for studies published between 1997 and 2015. A total of 194 articles met the inclusion criteria and were appraised in relation to: (i) selection method used; (ii) research question(s) addressed, and (iii) type of study design.

RESULTS

Eight selection methods were identified: (i) aptitude tests; (ii) academic records; (iii) personal statements; (iv) references; (v) situational judgement tests (SJTs); (vi) personality and emotional intelligence assessments; (vii) interviews and multiple mini-interviews (MMIs), and (viii) selection centres (SCs). The evidence relating to each method was reviewed against four evaluation criteria: effectiveness (reliability and validity); procedural issues; acceptability, and cost-effectiveness.

CONCLUSIONS

Evidence shows clearly that academic records, MMIs, aptitude tests, SJTs and SCs are more effective selection methods and are generally fairer than traditional interviews, references and personal statements. However, achievement in different selection methods may differentially predict performance at the various stages of medical education and clinical practice. Research into selection has been over-reliant on cross-sectional study designs and has tended to focus on reliability estimates rather than validity as an indicator of quality. A comprehensive framework of outcome criteria should be developed to allow researchers to interpret empirical evidence and compare selection methods fairly. This review highlights gaps in evidence for the combination of selection tools that is most effective and the weighting to be given to each tool.

Use of the Interview in Resident Candidate Selection: A Review of the Literature

BACKGROUND

Although the resident candidate interview is costly and time-consuming for both applicants and programs, it is considered critically important for resident selection. Noncognitive attributes, including communication skills and professionalism, can be assessed by the personal interview.

OBJECTIVE

We conducted a review of the literature on the residency interview to identify the interview characteristics used for resident selection and to ascertain to what extent the interview yields information that predicts future performance.

METHODS

We searched PubMed and Scopus using the following search terms: residency, internship, interview, selection, and performance. We extracted information on characteristics of the interview process, including type of interview format, measures taken to minimize bias by interviewers, and testing of other clinical/surgical skills.

RESULTS

We identified 104 studies that pertained to the resident selection interview, with highly varied interview formats and assessment tools. A positive correlation was demonstrated between a medical school academic record and the interview, especially for unblinded interview formats. A total of 34 studies attempted to correlate interview score with performance in residency, with mixed results. We also identified a number of studies that included personality testing, clinical skills testing, or surgical skills testing.

CONCLUSIONS

Our review identified a wide variety of approaches to the selection interview and a range of factors that have been studied to assess its effectiveness. More research needs to be done not only to address and ascertain appropriate interview formats that predict positive performance in residency, but also to determine interview factors that can predict both residents' "success" and program attrition.

Is orthopedics more competitive today than when my attending matched? An analysis of National Resident Matching Program data for orthopedic PGY1 applicants from 1984 to 2011

OBJECTIVE

This study evaluated supply and demand trends for orthopedic postgraduate year 1 (PGY1) positions from 1984 to 2011 for the purpose of estimating national intercandidate competition over time.

DESIGN

National Resident Matching Program (NRMP) data for orthopedic surgery from 1984 to 2011 were collected. Proxy variables including (total number of orthopedic applicants/number of orthopedic PGY1 positions), (number of US senior applicants to orthopedics/number of orthopedic PGY1 positions), (number of US seniors matching into orthopedics/number of US senior orthopedic applicants), (total number of matched orthopedic applicants/total number of orthopedic applicants), and (total number of US applicants who fail to match into orthopedics/total number of US senior applicants into orthopedics) as well as average United States Medical Licensing Examination Step 1 scores were used to gauge the level of competition between candidates and were compared over time.

SETTING

Academic medical center in the Midwestern United States.

PARTICIPANTS

Medical professors and medical students.

RESULTS

The NRMP data suggested that the number of positions per applicant decreased or remained stable since 1984 and that the percentage of applicants who did not match was no higher now than in the past. This finding was primarily because of the relative decrease in the ratio of applicants to available PGY1 positions, which stems from the number of positions increasing more rapidly than the number of applicants.

CONCLUSIONS

The NRMP data from 1984 to 2011 supported our hypothesis that intercandidate competition intensity for orthopedic PGY1 positions has not increased over time. The misconception that orthopedics is becoming more competitive likely arises from the increased number of applications submitted per candidate and the resulting relative importance placed on objective criteria such as United States Medical Licensing Examination Step 1 scores when programs select interview cohorts.

Applicant selection procedures in endodontic specialty programs in the United States: program director's perspective

INTRODUCTION

The purpose of this study was to determine the criteria evaluated by directors of endodontic specialty programs in the United States when selecting their residents and their satisfaction with the current process. Besides this, the study also aimed to determine the expected effect of the change in National Board Dental Examination (NBDE) score reporting to pass/fail on applicant evaluation.

METHODS

A 38-question web-based survey was distributed to the 54 endodontic specialty program directors (of 55 programs) in the United States. Questions regarded general program information, information obtained from applications, the interview process, the decision process, a retrospective view of the selection process, and director demographics.

RESULTS

Twenty-six (48.1%) responses were returned and analyzed. The most important application factors were interview ratings, dental school class rank, and general practice residency or advanced education in general dentistry experience. The most preferred sources for letters of recommendation were endodontic pre- and postdoctoral program directors and other academic endodontists. Desirable applicant characteristics included enthusiasm, listening skills, and verbal skills. Program directors indicated concern regarding the initial screening of applicants after the NBDE scoring change but not as much concern relating to final selection. Respondents generally supported a uniform acceptance date but did not support participation in the Postdoctoral Dental Matching Program (the Match).

CONCLUSIONS

Some important criteria when selecting prospective residents were identified. Program directors did not appear overwhelmingly concerned with the changes in NBDE score reporting. In addition, the establishment of a uniform acceptance date may resolve the biggest problem most respondents have with the current selection process.