Away Rotations in Obstetrics and Gynecology: A Survey of Program Directors

OBJECTIVE

To evaluate residency program director views on the purpose and value of an away rotation for students applying to a residency application in Obstetrics and Gynecology (OBGYN).

DESIGN, SETTING, AND PARTICIPANTS

The Council on Resident Education in Obstetrics and Gynecology administered a 28-question survey to current U.S. program directors in OBGYN in 2022. Program directors were asked if they offered away rotations to visiting medical students and if so, what the purpose the rotation played in their application process and whether rotating students were automatically offered a residency interview. Program characteristics such as program size, geographic location, and program type (university, community, or military based) were ascertained. A test of proportions was utilized to understand the relationship between program description and survey responses.

RESULTS

Seventy-nine percent (224/285) of OBGYN PDs responded to the survey and consented to participation. Programs were representative of the types of training program, size of programs, and geographic location. Of respondents, 77.2% (173/224) of PDs indicated that away rotations were offered at their institution, but only 26.6% (46/173) of residency PDs assessed prospective candidates for away electives. The opportunity to provide students an audition for a residency position was the most common reason to offer an elective. Only 34.7% (60/173) of OBGYN PDs guaranteed an interview to students who completed away electives at their institution. The majority (118/173, 68.2%) of PDs indicated less than 25% of their current residents had completed an away rotation with their program.

CONCLUSIONS

Many residency programs offered away electives to prospective applicants, but the majority did not personally assess applicants for competitiveness or guarantee interviews to students completing electives. To increase transparency in the application process, programs should publicize the purpose of away rotations and provide information on the number of interviews granted to students who complete away rotations.

Graduating Medical Students' Experiences with Away (In-Person and Virtual) Rotations During COVID-19: Analysis of the Association of American Medical Colleges (AAMC) 2021 Graduation Questionnaire (GQ)

OBJECTIVE

The COVID-19 pandemic disrupted students' opportunities for away rotations (ARs). Schools and specialty organizations innovated by supplementing in-person ARs (ipARs) with virtual ARs (vARs). We sought to determine how ipAR and vAR completion varied by intended specialty among 2021 graduates.

DESIGN

Using de-identified Association of American Medical Colleges 2021 Graduation Questionnaire (GQ) data, we examined AR completion by specialty and community-based school attendance (among other variables) in univariate analysis and multivariable logistic regression models.

SETTING

Students graduating from MD-degree granting U.S. medical schools were invited to complete the 2021 GQ, administered electronically on a confidential basis.

PARTICIPANTS

Our study included data for 15,451 GQ respondents (74% of all 2021 graduates).

RESULTS

Among GQ respondents, 18% (2,787/15,451) completed ARs: 8% (1,279/15,451) ipAR only, 8% (1,218/15,451) vAR only, and 2% (290/15,541) both. In univariate analysis, specialty and community-based school attendance (each p < 0.001), among other variables, were associated with ipAR and with vAR. In multivariable logistic regression, surgical specialties associated with greater odds of AR completion (vs. general surgery reference) included neurological surgery (ipAR: adjusted odds ratio [AOR]=1.9, 95% confidence interval [CI]=1.1-3.3; vAR AOR=3.1, 95% CI=1.9-4.9), ophthalmology (ipAR: AOR=2.3, 95% CI=1.6-3.3; vAR: AOR=2.5, 95% CI=1.7-3.7), orthopedic surgery (ipAR: AOR=2.5, 95% CI=1.8-3.4; vAR: AOR=12.4, 95%CI=9,2-16.5), otolaryngology (ipAR: AOR=1.8, 95% CI=1.2-2.8; vAR: AOR=4,8, 95% CI=3.4-6.9), plastic surgery (ipAR: AOR=2.1, 95% CI=1.2-3.5; vAR: AOR=13.9, 95% CI=9.3-20.7) and urology (ipAR: AOR=2,1, 95% CI=1.4-3.2; vAR: AOR=11.9, 95% CI=8.4-16.8). Community-based medical school attendance was also associated with greater odds of ipAR (AOR=4.6, 95% CI=3.1-6.7) and vAR (AOR=1.8, 95% CI=1.4-2.3).

CONCLUSIONS

The prevalence of AR completion was low. Differences we observed by specialty and medical school type aligned well with recommended circumstances for ipARs for the class of 2021. Substantial specialty-specific differences in vAR completion suggest that various surgical specialties were among the early innovators in this regard.

The Student You Know: Orthopedic Surgery Home Program Match Rates and Geographic Relationships Before and After COVID-19

OBJECTIVE

In March 2020, COVID-19 was declared a pandemic by the World Health Organization. This led to the outright cancellation of away rotations and in person residency interviews for the class of 2021. This study aims to identify the geographic relationships in the orthopedic match and further explore COVID-19's effect on these geographic relationships. Furthermore, we aim to compare the home program match rates before and after COVID-19.

SETTING

Southern Illinois University School of Medicine, Department of Orthopedic Surgery (tertiary, university-based).

DESIGN AND PARTICIPANTS

Residency websites and social media sites were used to record basic residency information as well as each resident's year, matriculated medical school, and matriculated medical school geographic data. This information was used to evaluate the proportion of orthopedic residents from "home program" medical schools and evaluate the geographic relationship of matched orthopedic residents. 202 Orthopedic residencies were initially identified and 134 allopathic and nonmilitary residency programs met the inclusion criteria. In all, 3253 of the 3931 (82.7%) current U.S orthopedic residents were included in the analysis.

RESULTS

In the 4 orthopedic surgery residency classes before the pandemic (2017-2020), 21.8% of residency slots were filled by home program students. During the pandemic match cycle (2021), this number jumped to 28.2% (p < 0.0006). The increase was observed consistently across residency subgroup analysis: class size, doximity rank, and doximity research rank. Correspondingly, there was a statistically significant increase from 34.7% (2017-2020) to 39.3% (2021) (p = 0.0318) in residencies matching with same state medical students. Regional trends stayed consistent. Our study showed that residency programs matched applicants who went to same region medical schools during the 2020 to 2021 cycle at nearly the exact same rate as they did pre-pandemic (63.6%, up from 63.3%).

CONCLUSIONS

Our study demonstrates that despite widespread virtual away rotations and virtual open houses, residency programs showed an increased preference for their home program students. This trend was significant and widespread, highlighting the generalized nationwide hesitation of both residency programs and students on the virtual interview process.

The Impact of Visiting Rotations on the Urology Residency Match: Insights and Perspectives from the 2021-2022 Applicants

OBJECTIVE

To survey 2022 Urology Residency Match applicants on their away rotation experiences to better understand the impact of pandemic changes, including the one in-person away rotation limit, on interviews and match outcomes.

METHODS

An anonymous post-match online survey was distributed to applicants of study-participating institutions. Data was prospectively collected regarding respondent demographics, away rotation experiences, interviews, utilization of preference signaling, and overall match outcomes.

RESULTS

In total, 230 applicants completed the survey. Respondents prioritized geography (28.1%), program reputation (26.1%), and early notification (25.6%) as the top factors in determining whether to accept a rotation offer. The majority (93%) participated in a single away rotation, with nearly all respondents being offered a virtual interview from the program where they completed a visiting clerkship. Of those who declined away rotation offers, 56% were not offered an interview at the program they declined an offer from. The majority matched at either their home institution (20.8%), a program where they submitted a preference signal (22.2%), or a program where they completed an in-person away rotation (13%). Despite 46.3% of respondents reporting that their match outcome was negatively affected by the ability to rotate at only one away rotation, the majority were satisfied (70%) with their rotation selection based on match results.

CONCLUSIONS

For applicants, participation in visiting rotations plays a significant role in the match process. Further research regarding mechanisms to optimize the away rotation application process is needed as the capacity to do visiting electives expands in the post-pandemic environment.

Disparate Responses in Match Outcome across Competitive Surgical Subspecialties to Pandemic Era Constraints: An Analysis of Impacts of Minimal Auditions

OBJECTIVE

The Covid-19 pandemic eliminated nearly all visiting sub-internships. We seek to uncover match rate disparities across plastic surgery, otolaryngology, urology, and neurosurgery subspecialties with respect to in-person appraisals. These data aim to highlight the common practices as well as subtle differences that each subspecialty may be displaying in selecting their respective residency candidates.

DESIGN

We accessed publicly available online spreadsheets between March 24 to 27 specific to the following surgical subspecialties: plastic surgery, otolaryngology, neurosurgery, and urology. We collected available information including the matched applicants' medical school, the institution at which they matched, and whether they had previous communication with their matched program. This data was then used to record whether the applicant matched at their home institution.

SETTING

N/A PARTICIPANTS: N/A RESULTS: There was a statistically significant increase in the number of plastic surgery and otolaryngology applicants who matched at their home programs during the 2020 to 2021 application cycle. 12.1% and 17.2% of plastic surgery applicants matched at their home program in the 2018 to 2019 and 2019 to 2020 application cycles, compared to 25.0% during the 2020 to 2021 application cycle (p = 0.0345). Overall, 23.4% and 22.2% of otolaryngology applicants matched at their home program in the 2018 to 2019 and 2019 to 2020 application cycles, compared to 31.3% during the 2020 to 2021 application cycle (p = 0.0482). Neurosurgery and urology applicants did not demonstrate statistically significant differences in home match rates during the 2020 to 2021 application cycle (p = 0.164 and p = 0.105, respectively).

CONCLUSIONS

Covid-19 related restrictions in the 2020 to 2021 match cycle led residency programs to utilize novel selection mechanisms to evaluate applicants. Without visiting sub-internships during the 2020 to 2021 match cycle, some programs appear to have intentionally favored candidates with whom they were previously acquainted. The significantly higher number of international medical graduates and non-senior medical graduates among neurosurgery and urology residencies, respectively, likely washed out the home matching effect among these specialties but does not discount the importance of in-person appraisals.

Away Rotations at Integrated Thoracic Surgery Programs: Applicant and Program Director Perspectives

OBJECTIVE

Integrated thoracic surgery residency program (IP) applicants often complete away rotations to stand out from the objective standard criteria. Little is known about the perceptions of these rotations. We aimed to examine the perceptions of value, cost, and expectations of away rotations among IP applicants and program directors.

DESIGN

Between March and April 2020, anonymous electronic surveys were distributed through e-mails gathered from the Electronic Residency Application Service and the Accreditation Council for Graduate Medical Education IP email list. A follow-up email was sent to all applicants and program directors 1 week after the initial request to improve response rate. Questions assessed the cost, frequency, goals, and objectives for away rotations, as well as the perceived value of these experiences.

SETTING

United States PARTICIPANTS: All IP program directors and United States senior medical students who applied to our institution's IP during the 2019-2020 cycle.

RESULTS

Seventy-eight US medical students participated in the 2020 IP Match with 65 applicants applying to our institution's IP. Thirty-three responses were obtained from applicants who applied to our program (51% response rate). Survey responses were obtained from 8 program directors (31% response rate). Ninety-four percent of applicant respondents completed an IP away rotation (n = 31). Fifty-seven percent of these applicants spent on average $5000 in total for away rotations (n = 19). Overall, applicants felt that away rotations helped refine their perception of program location, educational and operative experience, treatment of medical students, and collegiality. Applicants and program directors acknowledged that creating a good impression and finding a compatible program were central values for participating in away rotations. However, program directors viewed the overall strength of the applicant as the most important factor when evaluating applicants. Fifty-five percent of applicant respondents matched at an IP (n = 17) with 35% matching at an IP where they had completed an away rotation (n = 6).

CONCLUSION

Extended interactions that can help create good impressions and establish compatibility are benefits to away rotations. However, given the current application conditions imposed by the pandemic, future studies should examine the impact of no away rotations on the IP Match process so that moving forward applicants and program directors can continue to weigh benefits to the costs and logistics of completing an away rotation.

Medical student experiences of applying into emergency medicine during the COVID-19 pandemic: A multi-institutional survey of emergency medicine-bound medical students

BACKGROUND

The COVID-19 pandemic added new and great uncertainty to the typical approach to applying into emergency medicine (EM) for medical students. There are little data on students' lived experience of applying during this time period. We performed a multi-institutional survey of EM-bound students' experiences with preparing to apply into EM during the pandemic.

METHODS

This was a cross-sectional survey design study of fourth-year students preparing to apply into EM during the 2020-2021 academic year. All self-identified EM-bound students at four participating institutions were recruited by email in June 2020 to participate in a 13-item, 5-point Likert-scale survey. Univariate descriptive statistics, response rate, and nonresponse bias were calculated.

RESULTS

Sixty-seven of 125 eligible students responded for an overall response rate of 53.6%. Nonresponse bias for specific survey items ranged from 0.01 to 0.12. Students rated the importance of securing an EM rotation at their home institution the highest of any item (mean ± SD = 4.81 ± 0.68). Students indicated higher satisfaction with advice from their department of EM (mean ± SD = 4.28 ± 0.75) than from their school of medicine (mean ± SD = 3.52 ± 0.89). Students indicated higher confidence in their home EM rotations' ability to assure adequate personal protective equipment (PPE; mean ± SD = 3.91 ± 0.83) than an away rotation (mean ± SD = 2.82, 1.09). Students reported feeling between moderately and quite stressed about applying into EM this year (mean ± SD = 3.49 ± 1.01), but reported the financial stress the lowest of any item (mean ± SD = 1.46 ± 0.84). Students rated it highly important that away rotations prioritize students from institutions without an EM residency (mean ± SD = 4.51 ± 0.93).

CONCLUSION

Medical students applying into EM during the COVID-19 pandemic felt confident in their EM advisors' recommendations and their home institution's PPE provision. Students with EM residency programs at their schools recognized the importance of away rotations being prioritized for students from schools without EM residency programs. Strong EM advising is important to students.

Improving the online presence of residency programs to ameliorate COVID-19's impact on residency applications

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has created several challenges for residency programs and prospective interns alike during the upcoming application cycle, including the cancellation of away sub-internships and in-person interviews. Given prior research documenting that applicants' application and ranking decisions are significantly influenced by residency webpages, a potential solution to the loss of in-person experiences during the pandemic is the expansion of residency programs' online presence through their program websites, provision of virtual grand rounds and pseudo-away rotations, and enhancement of virtual interviews. This study seeks to summarize the existing literature on these areas and provide concrete suggestions for improving programs' virtual presence.Methods: The authors summarize earlier literature querying the content of program websites across 14 medical specialties, which documented significant gaps in the content of interest to applicants.Results: Among 14 analyzed specialties, the majority of programs had a functional website (>90%), with the exception of interventional radiology (73.9%). However, significant gaps in content were documented, with the percentage of content variables contained on websites ranging from 33.3% to 70.5% (median = 47.0%, interquartile range = 37.8-52.6%). Program websites were also limited by underrepresentation of content most valued by applicants as well as potential areas of inaccurate or outdated information.Conclusions: There are several interventions programs can undertake to address existing gaps in online presence. During an application cycle facing unprecedented resource strain, bolstering the online presence of programs may facilitate an improved fit between programs and future residents.

Promoting Access of Osteopathic Medical Students to Surgical Residency Training Programs

The COVID-19 pandemic has uncovered disparities for allopathic and osteopathic surgical applicants for the upcoming 2021 residency application cycle. It has provided an opportunity for change to the current paradigm in surgical resident selection. This study seeks to quantify the disproportionality of opportunities between allopathic and osteopathic students and provides solutions to level the playing field for all applicants.