National Resident Matching Program Match Research Articles

Geographic Location and Corporate Ownership of Hospitals in Relation to Unfilled Positions in the 2023 Emergency Medicine Match.

In the 2023 National Resident Matching Program (NRMP) match, there were 554 unfilled emergency medicine (EM) positions before the Supplemental Offer and Acceptance Program (SOAP). We sought to describe features of EM programs that participated in the match and the association between select program characteristics and unfilled positions. The primary outcome measures included the proportion of positions filled in relation to state and population density, hospital ownership type, and physician employment model. Secondary outcome measures included comparing program-specific attributes between filled and unfilled programs, including original accreditation type, year of original accreditation, the total number of approved training positions, length of training, urban-rural designation, hospital size by number of beds, resident-to-bed ratio, and the percentage of disproportionate share patients seen. The NRMP Match had 276 unique participating EM programs with 554 unfilled positions. Six states offered 52% of the total NRMP positions available. Five states were associated with two-thirds of the unfilled positions. Public hospitals had a statistically significant higher match rate (88%) when compared to non-profit and for-profit hospitals, which had match rates of 80% and 75%, respectively (P < 0.001). Programs with faculty employed by a health system had the highest match rate of 87%, followed by clinician partnerships at 79% and private equity groups at 68% (P < 0.001 overall and between all subgroups). The 2023 match in EM saw increased rates in the number of residency positions and programs that did not fill before the SOAP. Public hospitals had higher match rates than for-profit or non-profit hospitals. Residency programs that employed academic faculty through the hospital or health system were associated with higher match rates.

"Home Field Advantage": The Presence of a "Home" Neurosurgical Residency Training Program is Associated With Improved Match Outcomes.

Competition for neurosurgical residency training positions remains fierce. The support provided by applicants' home neurosurgery residency training programs (NRTP) is suspected to play a key role in the National Resident Matching Program (NRMP) process. We sought to evaluate the impact of the presence of an Accreditation Council for Graduate Medical Education-accredited NRTP at medical students' home institutions has on NRMP match outcomes. Our cross-sectional observational study examined all US allopathic senior student Electronic Residency Application Service applications to a single NRTP from 2016 to 2022. We analyzed a total of 1650 Electronic Residency Application Service applications to a single NRTP, of which 1432 (86.8%) were from schools with an Accreditation Council for Graduate Medical Education-accredited NRTP (NRTP+) and 218 (13.2%) were from schools without a residency (NRTP-). NRTP+ applicants matched a higher rate on both pooled analysis (80.8% vs 71.6%, P = .002) and paired analysis (P = .02) over the seven-cycle study period. This difference was present before (82.4% vs 73.9%, P = .01) and after (77.2% vs 65.6%, P = .046) the COVID-19 pandemic. Cohorts were overall similar; however, NRTP+ applicants had more publication experiences (19.6 ± 19.0 vs 13.1 ± 10.2, P < .001) and were more likely to complete a research gap year (RGY) (25.8% vs 17.0%, P = .004). Completing a RGY was associated with an increased likelihood of matching for NRTP+ applicants but not for NRTP- applicants: NRTP+: 84.9% vs 78.1% (P = .0056); NRTP-: 70.3% vs 70.9% (P = .94). The presence of a NRTP at a medical student's home institution is associated with improved NRMP match outcomes. This held true both before and after the COVID-19 pandemic. Applicants from schools with a NRTP had more publication experiences and were more likely to complete a RGY. Completion of a RGY is associated with an increased likelihood of matching only for students with an affiliated NRTP.

Unfilled in emergency medicine: An analysis of the 2022 and 2023 Match by program accreditation, ownership, and geography.

The two most recent National Resident Matching Program (NRMP) Match cycles saw a high number of initially unfilled emergency medicine (EM) residency positions. We sought to identify the risk of EM residency program characteristics including accreditation duration, primary clinical site ownership status, and geography pertaining to not initially filling all positions. We performed a repeated cross-sectional observational study of EM residency programs participating in the 2022 and 2023 NRMP Match cycles and used publicly available data from the NRMP, the Accreditation Council for Graduate Medical Education, the Centers for Medicare & Medicaid Services, and the U.S. Department of Housing and Urban Development. Our primary outcome was the proportion of EM residency programs that did not initially fill positions, with analyses stratified by accreditation duration (>5 or ≤5 years), primary clinical site ownership status, and geographic core-based statistical areas (CBSAs). A total of 219 of 2921 (7.5%) positions in the 2022 Match and 554 of 3010 (18.4%) positions in the 2023 Match were initially unfilled. Over the 2-year period, EM residency programs accredited within the past 5 years had more than double the risk (relative risk [RR] 2.08, 95% confidence interval [CI] 1.69-2.57, chi-square p < 0.001) of not filling all positions compared to those accredited more than 5 years previously. EM residency programs with a primary clinical site under for-profit ownership had a 50% greater risk of not filling all positions when compared to those under nonprofit or governmental ownership (RR 1.50, 95% CI 1.14-1.98, chi-square p = 0.009). In 2023, several CBSAs had a high number of both offered and unfilled positions. EM residency programs accredited within the past 5 years or those with a primary clinical site under for-profit ownership had a greater risk of not filling all positions within the past two Match cycles.

Early vs Single Match in the Transition to Residency: Analysis Using NRMP Data From 2014 to 2021.

An Early Result Acceptance Program (ERAP) has been proposed for obstetrics and gynecology (OB/GYN) to address challenges in the transition to residency. However, there are no available data-driven analyses on the effects of ERAP on the residency transition. We used National Resident Matching Program (NRMP) data to simulate the outcomes of ERAP and compare those to what occurred in the Match historically. We simulated ERAP outcomes in OB/GYN, using the de-identified applicant and program rank order lists from 2014 to 2021, and compared them to the actual NRMP Match outcomes. We report outcomes and sensitivity analyses and consider likely behavioral adaptations. Fourteen percent of applicants receive a less preferred match under ERAP, while only 8% of applicants receive a more preferred match. Less preferred matches disproportionately affect DOs and international medical graduates (IMGs) compared to US MD seniors. Forty-one percent of programs fill with more preferred sets of applicants, while 24% fill with less preferred sets of applicants. Twelve percent of applicants and 52% of programs are in mutually dissatisfied applicant-program pairs (a pair in which both prefer each other to the match each received). Seventy percent of applicants who receive less preferred matches are part of a mutually dissatisfied pair. In 75% of programs with more preferred outcomes, at least one assigned applicant is part of a mutually dissatisfied pair. In this simulation, ERAP fills most OB/GYN positions, but many applicants and programs receive less preferred matches, and disparities increase for DOs and IMGs. ERAP creates mutually dissatisfied applicant-program pairs and problems for mixed-specialty couples, which provides incentives for gamesmanship.

The US Residency Match at 70: What Was, What Is, and What Could Be.

The US Residency Match at 70: What Was, What Is, and What Could Be.

Otolaryngology Residency Match During the COVID-19 Pandemic.

ObjectiveTo review changes made by otolaryngology residency program directors (PDs) during the 2020-2021 National Resident Matching Program (NRMP) match cycle and describe their attitudes toward the 2021-2022 match cycle.MethodsCross-sectional study using an anonymous 31-item online survey in Research Electronic Data Capture (REDCap) with questions regarding the 2020-2021 NRMP match. This survey was distributed to 125 PDs from Accreditation Council for Graduate Medical Education (ACGME)-accredited otolaryngology residency programs.ResultsThirty-three PDs responded (26.4%). Of the PDs, 78.8% had an online info-session prior to the start of the cycle, and 30.3% reported that an increased number of applicants contacted them compared to the prior cycle. There were no changes made in Step 1 criteria (72.7%), and 81.8% reported no changes in interview selection. Of the PDs, 54.5% reported interviewing more candidates. Respondents reported a decreased cancellation rate (66.7%) and cost of recruiting (87.9%); 87.9% said that they did not change the way they developed their rank order list (ROL), and 84.8% reported matching at their usual level compared to prior years. Of the respondents, 42.4% reported making a change that was an overall improvement for their program. Of the PDs, 34.4% were unsure whether they would sustain virtual interviews in 2021-2022, 25% stated that they would not incorporate virtual interviews, and 40.7% stated that they would incorporate a virtual interview in some part of the cycle.ConclusionOtolaryngology PDs approached virtual interviewing in different ways. Despite the changes made, applicants can find comfort in knowing that match outcomes were perceived as typical by a majority of PDs.

147 An Exploratory Study Investigating the Use of a Resident-Driven Virtual Webinar Series for Residency Program Recruitment

Traditional residency program recruitment relies on in-person events such as residency fairs, social events, interviews with faculty and residents, and tours of the hospital and surrounding neighborhoods. The 2020-2021 recruitment season was dramatically impacted by the COVID-19 pandemic and required that all recruitment shift rapidly to a fully virtual model. Applicants were suddenly limited to online exploration only. Both as digital natives and as people intimately familiar with the daily life within the residency program, current residents were uniquely positioned as tech-savvy resources for applicants. Our residency program hosted six resident-driven virtual webinar sessions as a core part of our recruitment strategy. The impact of a fully virtual residency recruitment season is unknown. In this exploratory study we attempt to determine the impact of our resident-driven virtual webinar series (RDVWS) on the attitudes of our incoming intern class about our residency program. This was a mixed-methods exploratory study. Participants were 18 rising interns who just completed the National Resident Matching Program (NRMP) process and were selected for 2021 Emergency Medicine categorical PGY-1 positions at a single urban three-year community-based residency program. The RDVWS was conducted in July-September 2020 prior to the opening of the Electronic Residency Application Service (ERAS) platform. Attending RDVWS was not required to apply to the program. The content of each session was based on topics that applicants are commonly interested in when applying. For instance, the topics ranged from: an alumni panel, the residency curriculum, sub-specialty opportunities, clerkship rotation information, and diversity and inclusion goals. We advertised the RDVWS via social media and through medical schools with a link to our registration page. The residents running the webinar invited faculty, residents and alumni from the program and moderated the sessions. Following the NRMP Match, an anonymous online survey, consisting of multiple choice and free text responses, was distributed to the 18 participants. Descriptive statistics were used to analyze the survey data in order to assess the impact of the RDVWS on rank list preference and value of the RDVWS. Additional qualitative data will be captured through focus groups in July 2021 during intern orientation. 94% (17/18) of matched interns responded to the survey. 59% (10/17) said they watched the RDVWS, while 41% of participants did not watch the VWS. Of the participants who watched the RDVWS, 70% (7/10) said they ranked MMC higher on their rank lists specifically because of the VWS. 24% (4/17) participants stated this affected their decision to apply to the residency program. Representative free text responses included: “Getting to watch how you all interacted… I wanted to know what the family dynamic was.” “The talk about the curriculum, event medicine and international EM month, and... patient population... align with what I want to do.” Preliminary data analysis reveals that students found RDVWS a helpful resource during the NRMP match, and many RDVWS participants cited the webinar as a reason they ranked our program higher on their match lists. We plan to present additional qualitative data by the time of ACEP21. In conclusion, we believe that the VWS is a valuable recruitment tool to supplement the interview experience.

Impact of Match Violations on Applicants' Perceptions and Rankings of Residency Programs.

IntroductionThe National Resident Matching Program (NRMP) requires all Match participants to adhere to a strict code of conduct known as the Match Participation Agreement, yet Match violations continue to occur. We sought to determine how interview experiences, including Match violations, impact applicants’ perceptions and rankings of residency programs.MethodsAn electronic survey was sent to all accredited medical school Deans of Student Affairs and Association of American Medical Colleges Student Representatives for distribution to fourth-year medical students. Questions assessed pressures that residency programs placed on applicants during interview season and their impact on applicants. Both quantitative and qualitative data were collected.ResultsOf the 433 included respondents, 31.2% (n = 135) reported breaches of the NRMP Match Participation Agreement. Of those, 63% (n = 85) had a negative perception of the violating programs, and 37.8% (n = 51) were less likely to rank those programs highly. Violations included asking applicants about the locations of their other interviews (60.3%, n = 261), pressuring applicants to reveal their ranking (24.0%, n = 104), explicitly requesting applicants to reveal their ranking (6.5%, n = 28), asking applicants to provide a commitment before Match day (3.9%, n = 17), and other behavior that was felt to ignore the spirit of the Match (16.4%, n = 71). Implying that applicants would match into a program if they ranked it highly (37.2%, n = 161) was received positively by 65.2% (n = 105) of applicants experiencing this breach, with 42.2% (n = 68) ranking the program more highly. Three major themes impacting applicants’ impressions of residency programs emerged from the qualitative data: interview experience, professionalism, and post-interview communication (PIC). Respondents overwhelmingly agreed that PIC should either be eliminated or that programs should set clear expectations for PIC.ConclusionsMatch violations continue to occur, despite the NRMP Match Participation Agreement. With the notable exception of communication implying that applicants would match into a program, applicants overwhelmingly view programs that commit these violations negatively and often rank these programs lower as a result.

Trends in the Physical Medicine and Rehabilitation Match: Analysis of NRMP Data from 2007 to 2018.

We provide an updated analysis of data about U.S. Physical Medicine and Rehabilitation (PM&R) residency program applicants collected by the National Resident Matching Program (NRMP). Analyze trends within NRMP data for PM&R residency match rates, compare matched to unmatched applicants, and compare PM&R applicants to other medical specialties. Secondary analysis of NRMP data. NRMP data set. Residency program applicants who participated in the NRMP Match, 2007 to 2018. Not applicable. Number of applicants, match rates, difference in characteristics including rank order list (ROL), U.S. Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) scores, publications, Alpha Omega Alpha (AOA) status, PhD degree, and experiences in research, volunteer, and work. Number of applicants and residency positions increased from 2007 to 2018. Length of ROL increased and was longer for matched compared to unmatched applicants, with maximum mean difference of 7.4 in 2016 (95% confidence interval [CI] 5.6-9.2). Matched U.S. Allopathic Seniors had higher USMLE scores compared to unmatched, with a mean difference of 12.7 for Step 1 (95% CI 8.3-17.0) and 12.6 (95% CI 8.6-16.6) for Step 2 CK (P< .001). Number of publications and volunteer experiences were higher for matched U.S. Allopathic Seniors (0.64, 95% CI 0.09-1.2 and 1.5, 95% CI 0.65-2.3, respectively). PM&R USMLE Step 1 and 2 CK scores increased at a significantly faster rate than for all other specialties, with estimated rate differences of 0.46 (95% CI 0.21-0.71) and 0.69 (95% CI 0.45-0.93) points per year, respectively. PM&R residency has become more competitive. USMLE Step 1 and 2 CK scores have outpaced the inflation of scores in other specialties. ROL length has increased, suggesting more ranked programs to successfully match. These analyses update our knowledge about PM&R residency applicants and suggest surrogate markers for a successful match.

Reimagining Residency Selection: Part 1-A Practical Guide to Recruitment in the Post-COVID-19 Era.

Reimagining Residency Selection: Part 1-A Practical Guide to Recruitment in the Post-COVID-19 Era.

Trends in Neuroradiology Fellowship Match in the United States: Analysis of the 13-Year National Resident Matching Program Data

The neuroradiology fellowship match is conducted by the National Resident Matching Program (NRMP) every year. The purpose of this study is to report the trends in neuroradiology match results from 2008 to 2020 in the United States (US) using data available from the NRMP. The fellowship match data was obtained from the NRMP archives. Data specific to programs (number of programs and filled positions) were obtained. Using the NRMP's "Charting Outcomes in the Match: Specialty Matching Service'' report, a detailed analysis of applicant characteristics broken down for each specialty, was also obtained for neuroradiology for the year 2018. Neuroradiology programs in the NRMP Match increased from 71 to 77 and the number of positions increased from 158 to 270 between 2008 and 2020. The fill rate of fellowship spots has remained steady at 75.9% in 2008 and 74.4% in 2020. The proportion of US allopathic medical graduates (US MD) amongst the filled spots decreased from 79.2% (2008) to 64.2% (2020), while the proportion of international medical graduates (IMGs) increased from 11.7% to 25.4%. US MD and IMG fill trends did not reach statistical significance (P = 0.78 and P = 0.92, respectively). US MDs had a higher number of research experiences and publications (23.2 and 26, respectively) when compared to US IMGs (5 and 7) and non-US IMGs (6.8 and 14.2). To conclude, over the last 13 years, the neuroradiology fellowship programs in the US have increased in number and expanded in size, with an almost stable fill rate of around 75%.

Preclinical Surgical Preparatory Course and the NRMP Match: Early Exposure and Surgical Recruitment a 10-Year Follow-Up

Many medical students mentally commit to specialties prior to entering clerkships. This is why early preclinical interactions with surgical specialties, through mentorship and/or interest groups, increases the opportunity to nurture enthusiasm for surgery. In 2007, a course providing preclinical medical students with introductory surgical skills training and preparation for the surgical environment ("SURG205") was established at our institution. The course underwent a major revision in 2016, increasing intraoperative mentorship by matching students to surgical attendings and requiring students to scrub into operative cases together. We anticipate that the positive surgical experiences created by the course will lead to further development and enhancement of student interest in surgical specialties-interest that we hypothesized would reflect in their National Resident Matching Program (NRMP) Match outcomes. NRMP results from 2010 to 2019 were cross-referenced with a database of students who participated in the SURG205 course from 2007 to 2016. With this, we examined the correlation between student participation in SURG205 and surgical specialty match. Descriptive statistics were used to review the trends of the NRMP results, and Pearson's correlation was used to determine the relationship and its significance. This study was conducted in a single private medical school in California. Specialties considered "surgical" included: General Surgery, integrated programs-such as Plastic, Thoracic, or Vascular surgery, Obstetrics and Gynecology, Orthopedic Surgery, Otolaryngology, Neurosurgery, and Urology. All other specialties were considered nonsurgical. Students identified as having participated in SURG205 and who then also took part in the NRMP. Seven hundred eighty students underwent the Match process from 2010 to 2019. 144 (18.5%) of these students participated in SURG205 between 2007 and 2016. Each Match class ranged in size from 62 to 91 (median = 77.5, IQR = 14.5) students. (Table 1) Two-hundred and nineteen students (28.1%) matched into a surgical specialty, of which 34 (15.5%) selected general surgery. From 2010 to 2019 the rate of students who matched into surgical specialties averaged 28.1% per year with a slight nonstatistically significantly increasing trend over that time period R2 = 0.30 (p = 0.09; Fig. 1). There was a significant increase in trend in proportion of students who took the course and matched into any specialty between 2010 and 2019 (R2 = 0.85, p = 0.0002; Fig. 2). And, there was a statistically significant positive relationship between students taking the course and matching into a surgical specialty (R2 = 0.63, p = 0.01; Fig. 3). Our results highlight the increasing tendency of students who pursue surgical specialties having previously participated in this early exposure courses. Not only is student interest created and encouraged through positive mentorship experiences, but that interest may be associated with increases in application rates and eventual match into the specialty. General surgery training programs might consider these trends when designing courses to ease transitions into first-year residency positions-such as fourth-year surgical boot camps, surgical procedure-based anatomy courses, and mentorship frameworks. This information further justifies the cost and time commitment required to administer these programs for students.

Determinants of medical specialty competitiveness

BackgroundAlthough the concept of medical specialty competitiveness may seem intuitive, there are very little existing empirical data on the determinants of specialty competitiveness in USA. An understanding of the determinants...

Multispecialty involvement in the management of type B aortic dissections in the endovascular era-Implications for training cardiothoracic residents.

Involvement of qualified specialists with proficiency in endovascular therapies has created flux regarding the role of cardiothoracic surgeons, vascular surgeons, and other catheter-skilled specialists in the management of type B aortic dissections. We used manuscript authorship trends and recent match data in order to study how multi-specialty involvement in treating aortic dissections has changed in the endovascular era. A PubMed review of published literature between 1998 and 2015 was performed with "aortic dissection" in the title. Case studies and entries with incomplete author or identifying information were excluded. Author number, specialty affiliation, and treatment focus were recorded. Available residency match data were obtained from the National Resident Matching Program (NRMP). Cardiothoracic surgeons represented 38.5% (10/23) of the authors for papers with an endovascular focus in 1998 compared with 27.7% (59/213) in 2015. Vascular surgeons represented 19.2% (5/23) and 37.1% (79/213) of authors in 1998 and 2015, respectively. Radiologists accounted for 30.4% (7/23) of authorship in 1998 and 8.9% (19/213) in 2015. NRMP match data revealed a 10.6% decrease in thoracic surgery matches from 2004 to 2015, while vascular surgery and interventional radiology increased by 74.7% and 191.1%, respectively. Endovascular technologies have resulted in significant changes as to which specialties manage complicated type B aortic dissections. Vascular surgeons, with both open and extensive endovascular training are optimally positioned to assume a major role in the care of aortic dissection patients. Continued emphasis on endovascular training and multispecialty collaboration is essential for cardiothoracic surgeons in the endovascular era.

Benchmarks for Support and Outcomes for Internal Medicine-Pediatrics Residency Programs: A 5-Year Review

Combined internal medicine and pediatrics (medicine-pediatrics) residencies were Accreditation Council for Graduate Medical Education (ACGME) accredited separately from their corresponding categorical residencies in June 2006. We investigated how ACGME accreditation of medicine-pediatrics programs has affected the levels of support (both financial and personnel), the National Resident Matching Program (NRMP) match rate, performance on the board examination, and other graduate outcomes. From 2009 through 2013 we sent an annual SurveyMonkey online survey to members of the Medicine-Pediatrics Program Directors Association. Questions pertained to program characteristics, program director support, recruitment, ambulatory training, and graduate data. More than 79% of responders completed the entire survey for each year (sample size was 60 program directors). Compared to the time prior to accreditation of the specialty, there was an increase in program directors who are dually trained (89% versus 93%), an increase in program director salary ($134,000 before accreditation versus $185,000 in 2013, P < .05), and an increase in the average full-time equivalent support (0.32 before accreditation versus 0.42 in 2013, P < .05). There was also an increase in programs with associate program directors (35% versus 78%), programs with chief residents (71% versus 91%), and an increase in program budgets controlled by program directors (52% versus 69%). The 2013 NRMP match rates increased compared to those of 2005 (99% versus 49%). Performance on the American Board of Pediatrics examination was comparable to that for pediatrics residents. Since accreditation, a larger number of residents are choosing careers in hospital medicine. Our data show widespread improved support for medicine-pediatrics programs since the 2006 start of ACGME accreditation.

The Ethics of the Match

—Potter Stewart Honesty and enthusiasm should go hand in hand when determining a future in the field one has chosen. However, the National Resident Matching Program (NRMP) match process is a stressful time during which candidates and programs struggle to balance enthusiasm and honesty with self-interest. The NRMP match first started in 1952 to create a uniform date to accept residency offers. After Sir William Osler started the first residency program in 1889, competition among hospitals for incoming residents led to increasingly early offers of internships to students. Hospitals had limited information about students’ performance, and applicants had to accept or reject positions without knowing which other offers might be forthcoming [1]. The match algorithm addressed students’ struggles with short deadlines and hospitals’ need to scramble for available students [2]. However, decades after its creation, issues still arise in the process. In particular, postinterview, prematch communication has caused frustration for both program directors and applicants alike, as presented in a previous letter to the editor in JACR [3]. In another survey, 94% of programdirectors felt that theNRMP process placed their programs in the position of having to be dishonest

Internal Applicants to Pediatric Emergency Medicine Fellowships and Current Use of the National Resident Matching Program Match: A Survey of Fellowship Directors.

Applicants to fellowship programs are divided into the following 2 distinct groups: the external versus internal candidate. Internal fellowship candidates did residency at the same institution they are applying to, whereas the external candidate is from another institution. Internal candidates have likely done rotation(s) within the fellowship's division and are known to faculty, whereas the external candidates are evaluated by their applications and interviews alone. Acceptance of internal fellowship candidates may be complicated by competing interests of the associated residency program and overlapping faculty who have academic roles in both training programs. The current percentage of pediatric emergency medicine (PEM) fellowships exclusively using the National Resident Matching Program (NRMP) Specialties Matching Service (SMS) for filling fellowship slots is not known. We surveyed all the current US PEM fellowship directors in April/May 2013 using a 15-question anonymous institutional review board-approved survey. This survey was hosted through http://www.surveymonkey.com and was available between April 08, 2013 and May 08, 2013. The unique link sent to each fellowship director recorded completion of the survey but no individual responses. All questions had to be answered for the results to be recorded. Fifty-four of 70 fellowship directors responded. Each question was individually evaluated. Fellowship directors had different feelings toward internal candidates. The NRMP-SMS exclusive use was high. Possible confounders using the NRMP match seemed uncommon. Twenty-nine percent of current PEM fellows are in training at the same institution where they completed their residency. Both internal and external candidates are valued by PEM fellowship directors. The exclusive use of the NRMP SMS is high and not confounded by internal factors.

The Prevalence and Nature of Postinterview Communications Between Residency Programs and Applicants During the Match

To examine the frequency and nature of postinterview communications between programs and applicants during the National Resident Matching Program (NRMP) Main Residency Match. The authors surveyed senior medical students at seven U.S. medical schools about postinterview communications with residency programs during the 2010 Match and analyzed the data. The response rate was 68.2% (564/827). Among respondents, 86.4% reported communicating with residency programs. Most (59.9%) reported telling more than one program they would rank it highly; 1.1% reported telling more than one they would rank it first. Students reported that programs told them they would be "ranked to match" (34.6%), be "ranked highly" (52.8%), or "fit well" (76.2%). Almost one-fifth (18.6 %) reported feeling assured by a program that they would match there but did not despite ranking that program first; 23.4% reported altering their rank order list based on communications with programs. In multivariate analysis, applicants to more competitive specialties were less likely to report being told they would be "ranked to match" (relative risk [RR] 0.72, 95% confidence interval [CI] 0.52-0.99). Applicants were more likely to report being told that they would be "ranked to match" if they received honors in the specialty clerkship (RR 1.39, 95% CI 1.10-1.77) or were members of Alpha Omega Alpha (RR 1.72, 95% CI 1.37-2.17). Reports of nonbinding communications with programs were frequent. Students should be advised to interpret any comments made by programs cautiously. Reported violations of the NRMP's Match Participation Agreement were uncommon.

First-Year Residents Who Began Their Graduate Medical Education in 2009–2010 and Found Their Positions Within and Outside the NRMP Match

Analysts who assess trends in medical specialty choice often use statistics published by the National Resident Matching Program (NRMP), but a substantial minority of new residents find their positions outside of the NRMP. Rule changes to be implemented by the NRMP in 2013 may have a substantial impact on this behavior.The author quantified and characterized residents who found their positions outside of the NRMP. Using available data, the author was able to distinguish those who were unsuccessful in the NRMP from those who did not register and those who registered but failed to enter a rank order list of preferred programs. NRMP data on applicants in 2009 (n = 36,971) were combined with data from the national resident census contained in the GMETrack system on residents who began their graduate medical education in 2009-2010 (n = 25,432). Residents were classified into categories based on their participation in the NRMP and their success in matching to a position, and by the type of medical school from which they graduated. Applicants who matched in the NRMP were 79.8% of new residents in first-year residency positions (n = 20,287). An additional 5.2% (n = 1,325) participated in the NRMP but were unsuccessful in matching. Aside from a small number of military residents, the remaining 13.7% (n = 3,488) found positions without participating in the NRMP Match. Workforce studies that rely on NRMP statistics alone to establish national trends are seriously deficient.

Out-of-Match Residency Offers: The Possible Extent and Implications of Prematching in Graduate Medical Education.

When the data from the National Resident Matching Program (NRMP) are used to analyze trends in medical students' career preferences, positions offered outside the match are omitted. The purpose of the study was to evaluate the extent and nature of out-of-match residency offers. We obtained total resident complements and postgraduate year-1 positions offered in 7 specialties in 2007 and compared these with the 2007 NRMP match data. We compared the percentage of positions offered outside the match to "success" in matching United States medical doctors (USMDs) and to the availability of fellowship positions, using the Spearman rank order test (SROT). A total of 18 030 postgraduate year-1 positions were offered in 9 specialty areas. Of 15 205 positions offered in the match, 54% were taken by USMDs. The percentage of outside-the-match offers was found to vary by specialty, from 7% in obstetrics-gynecology to 23% in internal medicine, and was inversely correlated with the specialty's "success" in matching USMDs (SROT = -0.87). The 3 nonprocedural primary care specialties (internal medicine, family medicine, and pediatrics) accounted for 10 091 (46.2%) of the 21 845 total positions offered in the match, with 4401 (43.6%) offered almost entirely to non-USMDs. Another 2467 positions were offered outside the match, resulting in 6868 positions offered to non-USMDs (55% of all primary care positions). In internal medicine, the percentage of outside-the-match offers was significantly and inversely associated with the availability of intrainstitutional fellowship programs (P < .0001). Prematching of independent applicants was significantly higher in primary care than in procedural-lifestyle programs (P < .0001). The NRMP's match data do not account for positions filled outside the match, a finding that appears to be significant. In 2007, 1 in 5 positions in primary care was offered outside the match.