Medical Residency Selection Research Articles

Association of performance in medical residency selection with a psychiatric diagnosis, and depressive and anxiety symptoms

Objective Few studies have focused on medical students and residents’ mental health impact on medical residency selection (MRS) performance. The authors evaluated the association of performance in MRS with depressive and anxiety symptoms and with a reported psychiatric diagnosis (rPD). Methods The authors enrolled candidates after the second round of MRS examinations at a Brazilian Medical School. Performance was assessed by final grade. Depressive and anxiety symptoms were assessed by the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) and the State-Trait Anxiety Inventory (STAI). The authors performed mediation analysis and multiple linear regression analysis to investigate the impact of rPD, state and trait anxiety, and depressive symptom severity on performance. Results 515 of the 643 MRS candidates (80.1%) participated in the study. Higher age, attending a preparatory course for MRS, rPD, and the number of MRS applications that year were associated with poorer performance. In mediation analysis, trait anxiety was associated with a direct effect on performance and an indirect effect mediated by rPD. Conclusion The data suggest that psychiatric diagnosis is associated with poorer performance on MRS, regardless of current symptoms of anxiety and depression. Additionally, increased levels of trait anxiety may negatively impact performance, directly and indirectly.

Strategies to Counteract Impact of Harmful Bias in Selection of Medical Residents.

Human biases impact medical care in ways that perpetuate health disparities. Research has demonstrated that biases negatively affect patient outcomes and stifle diversity across the physician workforce, further compounding health disparities by worsening patient-physician concordance. Taken as one, the application, interview, recruitment, and selection processes employed by residency programs has been one of the critical junctures where bias has exacerbated inequities among future physicians. In this article, the authors define diversity and bias, review the history of bias in residency programs' processes for selecting residents, explore the impact of this history on workforce demographics, and discuss ways to optimize and work toward equity in the practices used by residency programs to select residents.

Performance on Patient Experience Measures of Former Chief Medical Residents as Physician Exemplars Chosen by the Profession

Physicians' knowledge about each other's quality is central to clinical decision-making, but such information is not well understood and is rarely harnessed to identify exemplars for disseminating best practices or quality improvement. One exception is chief medical resident selection, which is typically based on interpersonal, teaching, and clinical skills. To compare care for patients of primary care physicians (PCPs) who were former chiefs with care for patients of nonchief PCPs. Using 2010 to 2018 Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data (response rate, 47.6%), Medicare claims for random 20% samples of fee-for-service beneficiaries, and medical board data from 4 large US states, we compared care for patients of former chief PCPs with care for patients of nonchief PCPs in the same practice using linear regression. Data were analyzed from August 2020 to January 2023. Receiving the plurality of primary care office visits from a former chief PCP. Composite of 12 patient experience items as primary outcome and 4 spending and utilization measures as secondary outcomes. The CAHPS samples included 4493 patients with former chief PCPs and 41 278 patients with nonchief PCPs. The 2 groups were similar in age (mean [SD], 73.1 [10.3] years vs 73.2 [10.3] years), sex (56.8% vs 56.8% female), race and ethnicity (1.2% vs 1.0% American Indian or Alaska Native, 1.3% vs 1.9% Asian or Pacific Islander, 4.8% vs. 5.6% Hispanic, 7.3% vs 6.6% non-Hispanic Black, and 81.5% vs. 80.0% non-Hispanic White), and other characteristics. The Medicare claims for random 20% samples included 289 728 patients with former chief PCPs and 2 954 120 patients with nonchief PCPs. Patients of former chief PCPs rated their care experiences significantly better than patients of nonchief PCPs (adjusted difference in composite, 1.6 percentage points; 95% CI, 0.4-2.8; effect size of 0.30 standard deviations (SD) of the physician-level distribution of performance; P = .01), including markedly higher ratings of physician-specific communication and interpersonal skills typically emphasized in chief selection. Differences were large for patients of racial and ethnic minority groups (1.16 SD), dual-eligible patients (0.81 SD), and those with less education (0.44 SD) but did not vary significantly across groups. Differences in spending and utilization were minimal overall. In this study, patients of PCPs who were former chief medical residents reported better care experiences than patients of other PCPs in the same practice, especially for physician-specific items. The study results suggest that the profession possesses information about physician quality, motivating the development and study of strategies for harnessing such information to select and repurpose exemplars for quality improvement.

Remote interviews for medical residency selection during the initial COVID-19 crisis: a national survey

BackgroundMedical training programs candidate’s interview is an integral part of the residency matching process. During the coronavirus disease 2019 (COVID-19) pandemic, conducting these interviews was challenging due to infection prevention restrains (social distancing, namely) and travel restrictions. E-interviews were implemented by the Saudi Commission for Healthcare Specialties (SCFHS) since the matching cycle of March 2020 to hold the interviews in a safer virtual environment while maintaining the same matching quality and standards.AimThis study was conducted to assess the medical training residency program applicants’ satisfaction, stress, and other perspectives for the (SCFHS) March 2020 Matching-cycle conducted through an urgently implemented E-interviews process.MethodA cross-sectional, nationwide survey (Additional file 1) was sent to 4153 residency-nominated applicants to the (SCFHS) March 2020 cycle.ResultsAmong the 510 candidates who responded, 62.2% applied for medical specialties, 20.2% applied for surgical specialties, and 17.6% applied for critical care and emergency specialties. Most respondents (61.2%) never had previous experience with web-based video conferences. Most respondents (80.2%) used the Zoom application to conduct the current E-interviews, whereas only 15.9% used the FaceTime application. 63.3% of the respondents preferred E-interviews over in-person interviews, and 60.6% rated their experience as very good or excellent. 75.7% of the respondents agreed that all their residency program queries were adequately addressed during the E-interviews. At the same time, 52.2% of them agreed that E-interviews allowed them to represent themselves accurately. 28.2% felt no stress at all with their E-interviews experience, while 41.2% felt little stressed and only 8.2% felt highly stressed. The factors that were independently and inversely associated with applicants’ level of stress with E-interviews experience were their ability to represent themselves during the interviews (p = 0.001), cost-savings (p < 0.001), their overall rating of the E-interviews quality (p = 0.007) and the speed of the internet connection (p < 0.006).ConclusionVideoconferencing was implemented on an urgent basis during the COVID-19 pandemic in the medical residency application process in Saudi Arabia. It was perceived as an adequate and promising tool to replace in-person interviews in the future. Applicants’ satisfaction was mainly driven by good organization, cost-saving, and their ability to present themselves. Future studies to enhance this experience are warranted.

Unraveling the medical residency selection game

The diversity of modern society is often not represented in the medical workforce. This might be partly due to selection practices. We need to better understand decision-making processes by selection committees in order to improve selection procedures with regard to diversity. This paper reports on a qualitative study with a socio-constructivist perspective conducted in 2015 that explored how residency selection decision-making occurred within four specialties in two regions in the Netherlands. Data included transcripts of the decision-making meetings and of one-on-one interviews with committee members before and after the group decision-making meetings. Candidates struggled to portray themselves favorably as they had to balance playing by the rules and being authentic; between fitting in and standing out. Although admissions committees had a welcoming stance to diversity, their practices were unintentionally preventing them from hiring underrepresented minority (URM) candidates. While negotiating admissions is difficult for all candidates, it is presumably even more complicated for URM candidates. This seems to be having a negative influence on attaining workforce diversity. Current beliefs, which make committees mistakenly feel they are acting fairly, might actually justify biased practices. Awareness of the role of committee members in these processes is an essential first step.

Designing for value in medical residency selection.

Given the growing number of selection tools, Foo and Hay challenge admissions designers to explicitly identify the value provided by each instrument they use.

The Correlation Between Students' Progress Testing Scores and Their Performance in a Residency Selection Process.

Brazil is currently seeing an increased number of medical schools, leading to high competition for medical residency vacancies. Public managers have thus considered Progress Testing scores potentially useful as part of the final decision in the medical residency selection process. We analyzed whether there is a correlation between students' Progress Testing scores and their performances in medical residency selection. We examined four subsequent cohorts of students who attempted Progress Testing yearly and compared their accumulated scores with their medical residency selection scores from Botucatu Medical School, Universidade Estadual Paulista. We included 212 students who finished the 6-year medical course in 2013, 2014, 2015, and 2016. The comparison between the area under the Progress Testing curve and the medical residency selection score was performed using a Pearson correlation, with a p value set at < 0.05. We found a positive association between the two scores (p < 0.05 for the 4 years). Next, the students were grouped according to their performance in Progress Testing: above one, within one, and below one standard deviation. A chi-square test was used to compare the rates of approval with the second step of the medical residency selection process. Approval rates were 91.7%, 69.2%, and 42.1%, respectively (p < 0.05). We conclude that, in fact, there is a correlation between students' performance on these measures. This is partially explained by the fact that both instruments measure cognitive competencies and knowledge. These data may support national policy changes for medical residency selection.

Creating an Evidence-Based Advising Program for Exams: a Student-led 10-Step Approach

Despite the significance of the United States Medical Licensing Examination (USMLE) in medical resident selection, there are few reports of evidence-based medical school advising programs for the USMLE and similar exams. Here, we describe a reproducible 10-step evidence-based, student-led process for developing an exam advising program, centered around a local needs assessment, literature review, multi-year study behaviors survey linked to meaningful score outcomes, and intentional dissemination of data to students. Student leadership promoted improved response rates, dissemination of findings, and student-centered programming. This 10-step approach is generalizable to development of advising programs for any standardized medical examination.

The multiple mini-interview for selecting medical residents: First experience in the Middle East region

Introduction: Numerous studies have shown that multiple mini-interviews (MMI) provides a standard, fair, and more reliable method for assessing applicants. This article presents the first MMI experience for selection of medical residents in the Middle East culture and an Arab country.Methods: In 2012, we started using the MMI in interviewing applicants to the residency program of Dubai Health Authority. This interview process consisted of eight, eight-minute structured interview scenarios. Applicants rotated through the stations, each with its own interviewer and scenario. They read the scenario and were requested to discuss the issues with the interviewers. Sociodemographic and station assessment data provided for each applicant were analyzed to determine whether the MMI was a reliable assessment of the non-clinical attributes in the present setting of an Arab country.Results: One hundred and eighty-seven candidates from 27 different countries were interviewed for Dubai Residency Training Program using MMI. They were graduates of 5 medical universities within United Arab Emirates (UAE) and 60 different universities outside UAE. With this applicant’s pool, a MMI with eight stations, produced absolute and relative reliability of 0.8 and 0.81, respectively. The person × station interaction contributed 63% of the variance components, the person contributed 34% of the variance components, and the station contributed 2% of the variance components.Discussion: The MMI has been used in numerous universities in English speaking countries. The MMI evaluates non-clinical attributes and this study provides further evidence for its reliability but in a different country and culture. The MMI offers a fair and more reliable assessment of applicants to medical residency programs. The present data show that this assessment technique applied in a non-western country and Arab culture still produced reliable results.

Are United States Medical Licensing Exam Step 1 and 2 Scores Valid Measures for Postgraduate Medical Residency Selection Decisions?

United States Medical Licensing Examination (USMLE) scores are frequently used by residency program directors when evaluating applicants. The objectives of this report are to study the chain of reasoning and evidence that underlies the use of USMLE Step 1 and 2 scores for postgraduate medical resident selection decisions and to evaluate the validity argument about the utility of USMLE scores for this purpose. This is a research synthesis using the critical review approach. The study first describes the chain of reasoning that underlies a validity argument about using test scores for a specific purpose. It continues by summarizing correlations of USMLE Step 1 and 2 scores and reliable measures of clinical skill acquisition drawn from nine studies involving 393 medical learners from 2005 to 2010. The integrity of the validity argument about using USMLE Step 1 and 2 scores for postgraduate residency selection decisions is tested. The research synthesis shows that USMLE Step 1 and 2 scores are not correlated with reliable measures of medical students', residents', and fellows' clinical skill acquisition. The validity argument about using USMLE Step 1 and 2 scores for postgraduate residency selection decisions is neither structured, coherent, nor evidence based. The USMLE score validity argument breaks down on grounds of extrapolation and decision/interpretation because the scores are not associated with measures of clinical skill acquisition among advanced medical students, residents, and subspecialty fellows. Continued use of USMLE Step 1 and 2 scores for postgraduate medical residency selection decisions is discouraged.

Experiência de prova prática na seleção para a residência médica: exeqüibilidade, segurança e importância deste processo de avaliação

Relata-se a experiência da realização de prova prática no concurso para seleção de médicos residentes no Centro Universitário Serra dos Órgãos, Teresópolis (RJ). Houve uma primeira fase com prova teórica (PT) de múltipla escolha e uma segunda fase com prova prática presencial (PP), ambas eliminatórias e classificatórias. As cinco áreas básicas do ensino médico foram avaliadas por meio do exame clínico de dois pacientes - um clínico ou cirúrgico e outro da área materno-infantil, conforme sorteio. A PP objetivou avaliar atitudes, habilidades e conhecimentos. Houve capacitação de dois tipos de bancas: a primeira com docentes das áreas clínica e cirúrgica, dita clínico-cirúrgica (CC), e a segunda com docentes das áreas de pediatria, tocoginecologia e saúde coletiva, chamada materno-infantil e preventiva (MIP). Não houve correlação significativa entre as notas da PT e as da PP. A PP foi determinante para a classificação final em cinco dos seis programas oferecidos. Houve correlação entre as notas das bancas CC e MIP (r = 0,483, p &lt; 0,001). Houve uniformidade das notas intrabanca e interbanca. A PP é exeqüível, segura e importante instrumento para a adequação do ensino de graduação em Medicina às diretrizes curriculares.

A prova prática no processo de seleção do concurso de residência médica

Um questionário estruturado relacionado à aplicação da prova prática no processo de seleção da residência médica foi aplicado durante o XLIII Congresso Brasileiro de Educação Médica, em Natal, em 2005. As competências julgadas importantes para a avaliação da prova prática e os diferentes modelos de prova aplicados por algumas instituições foram discutidos. Foi realizada aanálise SWOT (Strengths, Weaknesses, Opportunities, and Threats), ferramenta utilizada em planejamento estratégico, para avaliação do modelo (forças e fraquezas) e de sua aplicabilidade no ambiente externo, considerando as instituições do País (oportunidades e ameaças). Os estudantes que responderam o questionário consideraram conhecimento seguido de habilidades as competências mais importantes, enquanto atitude e comportamento ético foram considerados pelos preceptores de residentes. A maioria dos participantes considerou que o modelo de prova deveria ser regionalizado, apesar de isto conflitar com as diretrizes curriculares. A prova presencial com pacientes e o modelo que utiliza recursos de multimídia foram considerados os de mais fácil reprodução. Conclui-se que a forma de aplicação da prova prática como processo de seleção de médicos residentes, apesar de relevante, apresenta fragilidades e precisa ser amplamente discutida.