Electronic Residency Application System Research Articles

Parallel Application to U.S. Psychiatry Residency Programs: Trends in Frequency and Differences by Applicant Group, 2009-2021.

The present study examines trends of percent of applicants, number of specialties, and specialty combinations for psychiatry residency applicants applying to multiple specialties (parallel application). The authors conducted a retrospective analysis of data captured by the Association of American Medical Colleges Electronic Residency Application System for applicants to psychiatry residency between 2009 and 2021. The percent parallel-applying, the mean number of specialties, mean application counts, and frequency of specialty combinations with psychiatry residency were determined. The dataset described 67,261 applicants. The percentage parallel-applying decreased from 73.7% in 2009 to 60.0% in 2021. International Medical Graduates and U.S. International Medical Graduate parallel-applied at the greatest rate in each year. Applicants who were parallel-applying submitted larger numbers of applications compared to those who were single-specialty applying. Parallel application to psychiatry residency appears to be a common practice, but has decreased in frequency. However, the mean numbers of applications submitted to each specialty in parallel application combination and among single-specialty applicants have increased. This practice appears to have a disproportionate impact on international and osteopathic applicants. Additional efforts are needed to develop evidence-based advising tools to reduce the number of residency applications submitted to psychiatry programs.

Characterizing the Next Generation of Neurosurgeons: A Descriptive Analysis and Publicly Available Web Application of Neurosurgery Residency Programs’ Website Data

Neurosurgery program websites serve as a valuable resource for applicants. However, each website exists in isolation, and it can be difficult to understand the general trends in U.S. neurosurgery resident demographics. In the present study, we collected data from program websites and analyzed the trends in the demographics of the current U.S. neurosurgery residents. We used a program list obtained from the American Association of Medical Colleges Electronic Residency Application System to extract data from the current resident complement listed in each program's website, including program, year in program, medical school, sex (male vs. female), graduate and/or PhD degrees, and assessed the trends during 7 years of resident data using linear regression. We identified 116 neurosurgery residency programs in the United States, with 111 providing information on their current resident complement, yielding a dataset of 1599 residents. Of these 1599 residents, 348 (22%) were female, 301 (19%) had a graduate degree in addition to an MD or DO degree, 151 (9.4%) had a PhD degree, 300 (19%) had matched at the program affiliated with their medical school, and 121 (7.6%) had graduated from a foreign medical school. The proportion of matriculating female residents had increased an average of 2.1% annually (95% confidence interval, 0.6%-3.7%) from 2015 to 2021. The other demographic data had not changed significantly during the same period. In addition to summarizing the current resident demographics, our analysis identified a significant increase in the proportion of female residents between 2015 (15.1%) and 2021 (25.6%). This publicly available dataset should enable additional analyses of the evolution of neurosurgery resident demographics.

Recent Changes in Characteristics of Applicants and Matriculants to Thoracic Surgery Fellowships

The match rate for traditional thoracic surgery fellowships decreased from 97.5% in 2012 to 59.1% in 2021, reflecting an increase in applications. We queried whether characteristics of applicants and matriculants to traditional thoracic surgery fellowships changed during this time period. Applicant data from the 2008 through 2018 application cycles were extracted from the Electronic Residency Application System (ERAS) and Graduate Medical Education (GME) Track Resident Survey and stratified by period of application (2008-2014 vs 2015-2018). Characteristics of applicants and matriculants were analyzed. There were 697 applicant records in the early period and 530 in the recent period (application rate 99.6/year vs 132.5/year; P = 0.0005), and 607 matriculant records in the early period and 383 in the recent period (matriculation rate 87% vs 72%; P < 0.0001). There was no difference in representation of university-affiliated versus community-based general surgery residency programs among applicants comparing the periods. Higher proportions of applicants and matriculants in the early period trained in general surgery programs affiliated with a comprehensive cancer center or a thoracic surgery fellowship. Applicants and matriculants of the recent period had higher median numbers of journal publications and had higher impact factor journal publications. The increase in applicants for thoracic surgery training is primarily from general surgery trainees in residency programs not affiliated with a comprehensive cancer center or a thoracic surgery fellowship. The increased interest in thoracic surgery training was accompanied by overall enhanced scholarship production among the applicants and matriculants regardless of their residency characteristics.

Race, But Not Gender, Is Associated With Admissions Into Orthopaedic Residency Programs.

Orthopaedic surgery is one of the most competitive but least diverse surgical specialties, with ever-increasing academic achievements (such as test scores) shown by applicants. Prior research shows that white applicants had higher United States Medical Licensing Exam (USMLE) Step 1 and Step 2 Clinical Knowledge scores as well as higher odds of Alpha Omega Alpha status compared with Black, Hispanic, and other applicant groups. Yet, it still remains unknown whether differences in application metrics by race/ethnicity sufficiently explain the underrepresentation of certain racial or ethnic minority groups in orthopaedic residency programs. In this study, we sought to determine (1) the relative weight of academic variables for admission into orthopaedic residency, and (2) whether race and gender are independently associated with admission into an orthopedic residency. The Electronic Residency Application System (ERAS) data from the Association of American Medical Colleges (AAMC) and the National Board of Medical Examiners (NBME) of first-time MD applicants (n = 8966) for orthopaedic surgery residency positions in the United States and of admitted orthopaedic residents (n = 6218) from 2005 to 2014 were reviewed. This dataset is the first and most comprehensive of its kind to date in orthopaedic surgery. Academic metrics, such as USMLE Step 1 and Step 2 Clinical Knowledge scores, number of publications, Alpha Omega Alpha status, volunteer experiences, work experience, as well as race and gender, were analyzed using hierarchical logistic regression models. The first model analyzed the association of academic metrics with admission into orthopaedic residency. In the second model, we added race and gender and controlled for metrics of academic performance. To determine how well the models simulated the actual admissions data, we computed the receiver operating characteristics (ROC) including the area under curve (AUC), which measures the model's ability to simulate which applicants were admitted or not admitted, with an AUC = 1.0 representing a perfect simulation. The odds ratio and confidence interval of each variable were computed. When only academic variables were analyzed in the first model, Alpha Omega Alpha status (odds ratio 2.12 [95% CI 1.80 to 2.50]; p < 0.001), the USMLE Step 1 score (OR 1.04 [95% CI 1.03 to 1.04]; p < 0.001), the USMLE Step 2 Clinical Knowledge score (OR 1.01 [95% CI 1.01 to 1.02]; p < 0.001), publication count (OR 1.04 [95% CI 1.03 to 1.05]; p < 0.001), and volunteer experience (OR 1.03 [95% CI 1.01 to 1.04]; p < 0.001) were associated with admissions into orthopaedics while work and research experience were not. This model yielded a good prediction of the results with an AUC of 0.755. The second model, in which the variables of race and gender were added to the academic variables, also had a good prediction of the results with an AUC of 0.759. This model indicates that applicant race, but not gender, is associated with admissions into orthopaedic residency. Applicants from Asian (OR 0.78 [95% CI 0.67 to 0.92]), Black (OR 0.63 [95% CI 0.51 to 0.77], Hispanic (OR 0.48 [95% CI 0.36 to 0.65]), or other race groups (OR 0.65 [95% CI 0.55 to 0.77]) had lower odds of admission into residency compared with white applicants. Minority applicants, but not women, have lower odds of admission into orthopaedic surgery residency, even when accounting for academic performance metrics. Changes in the residency selection processes are needed to eliminate the lower admission probability of qualified minority applicants in orthopaedic residency and to improve the diversity and inclusion of orthopaedic surgery. Changes including increasing the diversity of the selection committee, bias training, blinding applications before review, removal of metrics with history of racial disparities from an interviewer's candidate profile before an interview, and use of holistic application review (where an applicants' experiences, attributes, and academic metrics are all considered) can improve the diversity landscape in training. In addition, cultivating an environment of inclusion will be necessary to address these long-standing trends in orthopaedic surgery. Race, but not gender, is associated with the odds of acceptance into orthopaedic surgery residency despite equivalent academic metrics. Changes in residency selection processes are suggested to eliminate the lower admission probability of qualified minority applicants into orthopaedic residency and to improve the diversity and inclusion of orthopaedic surgery.

Do Interviews Really Matter in Generating Programs and Applicants' Rank Lists for the Match?

A paucity of data exists on the role of the interview day in programs and applicants' final rank list. The objective of our study was to investigate the impact interview day has on our programs and our interviewees' final rank list. For the 2020 appointment year, our program used an Electronic Residency Application System Application Scoring Tool and Interview Scoring Tool to generate the preliminary rank list for our pulmonary and critical care fellowship applicants. The final rank list was decided after interviewers' discussion during the program's rank list meeting. We aimed to correlate the preliminary and final lists. We also surveyed applicants on the importance of interview day in generating their rank list. The final and the preliminary rank lists were strongly correlated (rs(47) = 0.87, P < 0.001). There was a stronger correlation between the final rank and the rank based on the application score (rs(47) = 0.84, P < 0.001) than the rank based on the interview score (rs(47) = 0.64, P < 0.001). For the postinterview survey, 48 applicants were surveyed-20 replied with a response rate of 42% and 18 respondents (90%) rated the interview experience as important or very important in their rank list decisions. The programs rank list correlated more with the candidates' written application than their interview day performance; however, interview experience greatly influenced the applicants' rank lists. In the coronavirus disease 2019 pandemic, in which all interviews are virtual, programs should make diligent efforts to construct virtual interview days, given their importance to applicants in generating their final rank list for the match.

Is There Unconscious Bias in the Orthopaedic Residency Interview Selection Process?

Orthopaedic surgery has historically been a white male-dominated field. Given the diverse patient population presenting to providers with musculoskeletal pathology, it is thought that it would be beneficial for the orthopaedic workforce to more closely mirror this patient population. This study aims to elucidate whether unconscious bias may have an effect on the scoring of applications for residency interview selection. Applications for the 2019-2020 residency match cycle were initially reviewed and scored by faculty members. Applications were then redacted of all information suggestive of race or gender and returned to evaluators for rescoring after at least 6 months. The pre and post-redaction data was compared using ANOVA and student's two-tailed t tests. Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University. Thirteen attending surgeons scored 320 2019-2020 Electronic Residency Application System (ERAS) applications, unblinded and blinded of applicant identifying information. Interviewed applicants were similar to the non-interviewed group in all measured variables except for higher pre-redaction scores (8.73-7.81; p = 0.02) which was expected (Table 2). Minority applicants had significant differences in Step 1 scores (243 vs 247; p < 0.01), Step 2 scores (251 vs 254; p = 0.01), articles (5.9 vs 3.8; p < 0.01), posters (5.9 vs 3.5; p < 0.01), and pre-redaction scores (7.44 vs 8.07; p = 0.01) compared to white applicants (Table 4). There was no relationship noted between step score and number or type of research items (Table 5). Pre-redaction and post-redaction scores were significantly different in white applicants who experienced a negative change (8.07-7.88; p = 0.03 (Table 6)). Males had statistically significant differences compared to females in Step 1 score (246 vs 243; p = 0.01) (Table 7). This study was unable to prove unconscious bias based on a lack of statistically significant change of score when blinded, however the direction in change of scores was unlikely to be accounted for exclusively by objective differences between applicants, suggesting a trend toward unconscious bias. It remains unclear how influential subjective portions of the ERAS application such as personal statements, Letters of Recommendation, hobbies, and activities are on the overall assessment of an applicant and whether or not unconscious bias manifests in these subjective portions. Further investigation is needed in this area. Until then, residency programs should take immediate measures to mitigate potential implicit bias in the residency interview selection process. Actions can include implicit bias training for all faculty members involved in resident selection, standardization of application scoring and possibly redacting all or portions of the ERAS application so that only objective academic markers are presented to evaluators. Gaining a better understanding of these barriers is not only essential for their removal, but also allows for better preparation of applicants for success in the match with the ultimate goal being to correct the persistent disparity in the field of orthopaedic surgery.

Impacts of COVID‐19 on orthopaedic surgery residency / spine trainee application trends

BackgroundThe COVID-19 pandemic has had widespread impact across medical educational sectors, including cancellations and delays of board exams, interruptions in clinical rotations and electives, altered processes for away rotations, and conversion to virtual interviews. These changes, combined with applicant and program uncertainty, may affect the 2021 residency application cycle for competitive fields such as orthopaedic surgery. In consideration of spine trainees and the spine fellow application pipeline, the current study aims to evaluate for deviations in trends found in applications to an orthopaedic surgery residency program from the 2021 cycle compared to six years prior. MethodsAfter institutional review board approval, applications to a single orthopaedic surgery residency program from application cycles 2015 to 2021 were evaluated in the Electronic Residency Application System (ERAS) and analyzed for trends. Supplementary information was taken from publicly available ERAS statistics. ResultsCompared to existing trends, the ERAS 2021 cycle had a greater number of applicants, more research items, and lower rates of USMLE Step 2 test administration. Of the 4,965 applications analyzed, no deviations in trends were found in number of female applicants, Black and Hispanic applicants, applicants from medical schools outside the US, DO applicants, applicants with interruptions in their training, or USMLE scores. ConclusionsThe orthopaedic surgery applicant pool increased amidst the COVID-19 pandemic and applicants had more research items than previous years. No significant deviations in the demographics of the applicant pool were noted. This is thought to be reassuring about the integrity of the orthopaedic residency application process / spine fellow application pipeline and should continue to be observed in the coming years.

No Longer a Match: Trends in Radiation Oncology National Resident Matching Program (NRMP) Data from 2010-2020 and Comparison Across Specialties

To report trends in the number and types of applicants and matched trainees to radiation oncology in comparison to other specialties participating in the National Resident Matching Program (NRMP) between 2010 and 2020. Data from the NRMP and Electronic Residency Application System (ERAS) were obtained for 18 medical specialties between 2010 and 2020. We assessed the numbers and types of applicants and matched trainees relative to available positions in the NRMP and Supplemental Offer and Acceptance Program (SOAP). In the 2020 NRMP, 122 US MD senior graduates preferentially ranked radiation oncology, a significant decrease from a median of 187 between 2010 to 2019 (interquartile range [IQR], 170-192; P < .001). Across all 18 specialties, radiation oncology experienced the greatest declines in the 2020 NRMP cycle relative to 2010 to 2019, in both the number of ERAS applicants from the United States and Canada (-31%) and the percentage of positions filled by US MD or DO senior graduates (-28%). Of 189 available positions, 81% (n = 154) filled in the NRMP prior to the SOAP, of which 65% (n = 122) were "matched" by US MD senior graduates who preferentially ranked radiation oncology as their top choice of specialty, representing a significant decrease from a median of 92% between 2010 to 2019 (IQR, 88%-94%; P = .002). The percentages of radiation oncology programs and positions unfilled in the NRMP prior to the SOAP were significantly increased in 2020 compared with 2010 to 2019 (programs: 29% vs 8% [IQR, 5%-8%; P < .001]; positions: 19% vs 4% [IQR, 2%-4%; P <.001]). Despite >99% (n = 127 of 128) of US MD or DO senior applicants preferring radiation oncology successfully matching to a radiation oncology position in the 2020 NRMP, 16 of 35 remaining unfilled positions were filled via the SOAP. Radiation oncology was the top user of the SOAP across all specialties participating in the 2020 NRMP, filling 15% of total positions versus a median of 0.9% (IQR, 0.3%-2.3%; P <.001). The supply of radiation oncology residency positions now far exceeds demand by graduating US medical students. Efforts to nullify a market correction revealed by medical student behavior via continued reliance on the SOAP to fill historical levels of training positions may not be in the best of interest of trainees, individual programs, or the specialty as a whole.

Characteristics of Matriculants to Thoracic Surgery Residency Training Programs

BackgroundThoracic surgery (TS) residency positions are in high demand. There is no study describing the nationwide attributes of successful matriculants in this specialty. We examined the characteristics of TS resident applicants and identified factors associated with acceptance. MethodsApplicant data from 2014 to 2017 application cycles was extracted from the Electronic Residency Application System and stratified by matriculation status. Medical education, type of general surgery residency, and research achievements were analyzed. The number of peer-reviewed publications and the corresponding impact factor for the journals where they were published were quantified. ResultsThere were 492 applicants and 358 matriculants. The overall population was primarily male (79.5%), white (55.1%), educated at United States allopathic medical schools (66.5%), and trained at university-based general surgery residencies (59.6%). Education at United States allopathic schools (odds ratio [OR], 2.54; P < .0001), being a member of the American Osteopathic Association (OR, 3.27; P = .021), general surgery residency affiliation with a TS residency (OR, 2.41; P = .0003) or National Cancer Institute designated Comprehensive Cancer Center (OR, 1.76; P = .0172), and being a first-time applicant (OR, 4.71, P < .0001) were independently associated with matriculation. Matriculants published a higher number of manuscripts than nonmatriculants (median of 3 vs 2, P < .0001) and more frequently published in higher impact journals (P < .0001). ConclusionsOur study includes objective and quantifiable data from recent application cycles and represents an in-depth examination of applicants to TS residency. The type of medical school and residency, as well as academic productivity, correlate with successful matriculation.

Discriminatory questions asked during residency programme interviews: perspective from both interviewers and applicants

BackgroundThe National Resident Matching Program (NRMP) policy requires interview officials to refrain from asking illegal or coercive questions that may introduce discrimination; however, compliance is insufficient.MethodAn Institutional Review Board-approved 12...

The International Medical Graduate

International medical graduates (IMGs) are graduates of medical schools located outside the United States (U.S.) and Canada. IMGs face various challenges on the road to U.S. residency training. These challenges include sitting for the United States Medical Licensing Examinations (USMLEs) to obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG). After that, IMGs are faced with a foreign application process whereby they must apply for and secure a position in a residency program through the Electronic Residency Application System (ERAS) and the National Resident Matching Program (NRMP). Once accepted into a residency program, IMGs who are not US citizens or legal permanent residents are challenged with securing a visa to be able to practice in the U.S. In this article, we elaborate on these processes and highlight the challenges IMGs may face along the way.

Characterization and Fate of Unpublished Research Articles Reported by Orthopedic Surgery Residency Applicants

As the competitiveness of matching to an orthopedic residency continues to increase, applicants attempt to bolster their application by participating in research activities. However, due to the brief duration of medical school, applicants' articles may not be published at the time of applying. The purpose of this study was to identify projects that were listed under "publications-other than published" within Electronic Residency Application System (ERAS) applications of prospective orthopedic surgery residents to determine the rate and time of these projects to future publication in a peer-reviewed journal. Program directors can use this information to help interpret the importance of such articles on the applications of future residency candidates. Retrospective study of prospective residents' applications to a single orthopedic residency program during the 2014 to 2015 application cycle were reviewed to identify articles designated as "other than published." Articles which advanced to official publication were confirmed using the Embase, PubMed, and Google Scholar databases. Applicant and article characteristics were recorded to identify variables associated with an increased proportion of articles that were able to be confirmed. Prospective residents to a single orthopedic residency program during the 2014 to 2015 application cycle. A total of 1957 article titles were listed amongst 563 applicants, with 48% of applicants (n = 271) having at least one peer-reviewed article listed as "other than published." Overall, 34.2% (709) of the articles were designated as being unpublished including 208 listed as accepted/in-press and 501 listed as submitted/under review. Of the accepted/in-press articles, 90.7% (n = 189) were able to be confirmed as successfully published papers, compared to 63.4% (n = 318) of articles designated as submitted/under review (p < 0.001). Factors predictive of articles which advanced to official publication were being accepted/in-press at the time of applying, a lower United States Medical Licensing Exam (USMLE) Step 1 score, and articles on orthopedic topics. Nearly one-half of orthopedic residency applicants report unpublished research articles on their ERAS application. While 90.7% of the articles listed as being accepted/ in press were eventually published, less than two-thirds of the articles designated as being in submission/under-review progressed to official publication.

Qualities and characteristics of applicants associated with successful matriculation to pediatric surgery fellowship training

BackgroundPediatric surgery (PS) is among the most competitive fellowship opportunities for general surgery residents. Prior investigations into factors associated with successful matriculation to PS have relied on surveys, which have inherent biases. Study designData were extracted from the Electronic Residency Application System for applicants from 2012 to 2017 and analyzed after stratification by matriculation status. ResultsData were gathered on a total of 444 applicants, of which 238 matriculated. The applicant pool was predominantly Caucasian (63.5%), largely graduated from US allopathic school (81%) and had a slight male predominance (54%), although the number of female applicants increased significantly over the study period. Attendance at a US allopathic medical school (OR=4.55, p <0.001), university-based general surgery training (OR=3.02, p <0.001) and training at institutions that offer PS fellowships (OR=3.36, p<0.001) were associated with matriculation. Matriculants had a higher quantity of peer reviewed publications (median 11 vs. 6, p <0.001) and published in high impact factor journals (p<0.001). A total of 65 applicants reapplied at least once, of whom 32% successfully matriculated. ConclusionsPS applicants' medical school, residency, and research data points correlated with successful matriculation. These data may help guide general surgery residents and medical students aspiring to become pediatric surgeons. Type of studyPrognosis study (retrospective) Level of evidenceLevel II

An Examination of Applicants and Factors Associated with Matriculation to Complex General Surgical Oncology Fellowship Training Programs.

The demand for training in complex general surgical oncology (CGSO) fellowships currently exceeds the number of positions offered; however, there are scarce data defining the applicant pool or characteristics associated with successful matriculation. Our study described the applicant population and to determine factors associated with acceptance into the fellowship. Data were extracted from the Electronic Residency Application System for applicants in 2015 and 2016 and stratified based on matriculation status. Applicant demographics, including medical education, residency, and research achievements, were analyzed. Academic productivity was quantified using the number of peer-reviewed publications as well as the journal with the highest impact factor in which an applicant's work was published. Data were gathered on a total of 283 applicants, of which 105 matriculated. The overall population was primarily male (63.2%), Caucasian (40.6%), educated at a U.S. allopathic medical school (53.4%), and trained at a university-based General Surgery residency (55.5%). Education at a U.S. allopathic school (OR = 5.63, p < 0.0001), university-based classification of the applicant's surgical residency (OR = 4.20, p < 0.0001), and a residency affiliation with a CGSO fellowship (OR = 2.61, p = 0.004) or National Cancer Institute designated Comprehensive Cancer Center (OR = 3.16, p < 0.001) were found to be associated with matriculation. Matriculants published a higher number of manuscripts than nonmatriculants (median of 10 vs. 4.5, p < 0.0001) and more frequently achieved publication in journals with higher impact factors (p < 0.0001). This study represents the first objective description of the CGSO fellowship applicant pool. Applicants' medical school, residency, and research data points correlated with successful matriculation.

Multicenter Validation of a Customizable Scoring Tool for Selection of Trainees for a Residency or Fellowship Program. The EAST-IST Study.

Few data have been published regarding scoring tools for selection of postgraduate medical trainee candidates that have wide applicability. The authors present a novel scoring tool developed to assist postgraduate programs in generating an institution-specific rank list derived from selected elements of the U.S. Electronic Residency Application System (ERAS) application. The authors developed and validated an ERAS and interview day scoring tool at five pulmonary and critical care fellowship programs: the ERAS Application Scoring Tool-Interview Scoring Tool. This scoring tool was then tested for intrarater correlation versus subjective rankings of ERAS applications. The process for development of the tool was performed at four other institutions, and it was performed alongside and compared with the "traditional" ranking methods at the five programs and compared with the submitted National Residency Match Program rank list. The ERAS Application Scoring Tool correlated highly with subjective faculty rankings at the primary institution (average Spearman's r = 0.77). The ERAS Application Scoring Tool-Interview Scoring Tool method correlated well with traditional ranking methodology at all five institutions (Spearman's r = 0.54, 0.65, 0.72, 0.77, and 0.84). This study validates a process for selecting and weighting components of the ERAS application and interview day to create a customizable, institution-specific tool for ranking candidates to postgraduate medical education programs. This scoring system can be used in future studies to compare the outcomes of fellowship training.

The Influence of Medical Liability Premiums on Obstetrics and Gynecology Specialty Selection

INTRODUCTION: The objective of this study was to determine if statewide malpractice premiums correlate with rates of selection of obstetrics–gynecology specialty by U.S. medical graduates during the years 2001–2005. METHODS: Longitudinal cohort study involving U.S. medical graduates applying through the Electronic Residency Application System. All applicants to obstetrics and gynecology residency programs from 2001 to 2005 were identified and pooled by medical school. State medical liability premium data were abstracted from national survey data. Correlation of the proportion of students matching into obstetrics–gynecology to mean state liability premium was analyzed on a state-by-state level, then by annualized premium tercile, and overall median national liability premium. RESULTS: A total of 82,709 graduates from 122 schools in 45 states were identified, of whom 4,926 matched into obstetrics–gynecology. During the study period, the median liability premium in the United States increased from $40,093 to $74,447. The state-by-state analysis revealed a poor correlation between the obstetrics–gynecology selection rate and medical liability premium (R2=0.06). Categorical analysis by annualized premium tercile revealed a statistically significant relationship between malpractice premium tercile and obstetrics–gynecology selection frequency (lower tercile: premium=$35,228, selection frequency=6.92%; middle tercile: premium=$55,150, selection frequency=6.30%; upper tercile: premium=$89,930, selection frequency=5.47%; P<.001). The overall U.S. analysis similarly revealed a statistically significant relationship between premiums and selection of obstetrics–gynecology (R2=0.80, P=.04). CONCLUSIONS: Increasing state medical liability premiums were inversely correlated to decreased selection rates of obstetrics–gynecology as a career by U.S. medical graduates during the most recent period of medical malpractice crisis.

Should Medical Grades be Standardized? Improving the Resident Selection Process

Should Medical Grades be Standardized? Improving the Resident Selection Process

A survey of demographics, motivations, and backgrounds among applicants to the integrated 0 + 5 vascular surgery residency

The 0 + 5 integrated vascular surgery (VS) residency has altered the training paradigm for future vascular specialists. Rising interest in these novel programs highlights our need to better understand the applicant pool. We compared demographics and surveyed recent applicants to our integrated program to gain more insight into their background and motivation for accelerated vascular training. Demographics and objective parameters were determined from all 65 applicants to the integrated VS program at Stanford University Medical Center and compared to 58 applicants interviewed by the general surgery (GS) program at Harbor-UCLA Medical Center by querying the Electronic Residency Application System for the programs in 2009. There was no overlap of applicants between programs. An anonymous, voluntary Web-based survey was sent to these cohorts with a response rate of 82% for VS applicants and 60% for GS applicants. Subjects were queried regarding their background, personal experience, prior exposure to VS, and motivations for residency specialty selection. Applicants to integrated VS programs tended to be older, were less likely to be from a US medical school, had a higher number of publications, and a higher percentage of cardiovascular-related publications than the GS applicants. When stratified by the 27 VS applicants (41%) that were offered an interview, this highly selected and desirable group for training was nearly 40% female, more likely to have an additional degree (PhD, master's), just as likely to be in the top quartile of their medical school class (60%), and score equally well on standardized board examinations (90th percentile) than the top GS applicants offered interviews. Survey data revealed that the majority of career choices (65%) were made during the third and fourth years of medical school. Factors most strongly influencing the decision to choose VS as a career were endovascular technologies/devices, challenging open vascular operations, clinical rotations on vascular surgery, the aging patient population, and perceived need for vascular surgeons and vascular surgeon mentorship. The most common reasons cited for particularly pursuing an integrated 0 + 5 VS training program were (1) more focused training/integration of cardiovascular medicine, (2) interest in catheter-based endovascular therapies, and (3) shorter time in training. Of the GS applicants, 58% indicated they would be interested in applying to an integrated residency in their subspecialty of interest, and 45% listed vascular surgery as a potential fellowship option after general surgery. Applicants to 0 + 5 integrated vascular residencies were more likely to have rotated on a vascular surgery service, observed vascular cases, identified a vascular surgery mentor, and been actively involved in cardiovascular research. The quality of the top VS applicant based on class rank and test scores is comparable to the top GS applicants, yet the VS applicant has a higher percentage of advanced degrees, more publications, and more involvement in cardiovascular research. Institutional strategies to increase medical student exposure to vascular surgery clinically and via research programs will optimize our ability to attract and train the best candidates in these new training programs.

A Critical Analysis of Personal Statements Submitted by Radiology Residency Applicants 1

Each year, radiology residency program directors and selection committees receive hundreds of applications for a limited number of residency positions in the field. Selection committees are often forced to make difficult decisions in order to rank academically similar applicants based solely on their application materials. With the advent of the Electronic Residency Application System (ERAS), the application has become standardized, making it even more difficult for applicants to distinguish their applications. To this end, the personal statement is considered a critical part of any radiology residency application, being one of the few chances applicants have to express their personality to a residency selection committee (1–5). Applicants often agonize for weeks over what should or should not be included. A brief search of the internet using a common search engine (www.google.com; Google, Mountain View, CA) and the key words “personal statement” and “residency” revealed multiple websites advertising personal statement writing, editing, and “assistance” services to applicants for significant fees. The fact that these services exist implies that, from an applicant’s perspective, the personal statement is a vital component of the application. The personal statement remains, however, a very subjective measure of an applicant’s value. There is no standardized measure of what defines an effective personal statement versus an ineffective one. Although those who read personal statements for an admissions committee seem to have an abstract sense of “good” personal statements and “bad” per-