Residency Application Research Articles

Use of Signaling in Family Medicine Residency Interviewing.

Although signals have been used in the residency application process by other specialties, family medicine residency directors have not previously participated. With applicant signal information available for the first time in the 2023-2024 application cycle, the current study describes family medicine residency program directors' intended use of signals and provides benchmarking descriptive data that may help inform best practices and future studies. A total of 691 of the 745 family medicine program directors in US family medicine residency programs accredited by the Accreditation Council for Graduate Medical Education were surveyed. We used ꭓ2 and Pearson correlation analyses to examine how program directors of family medicine residency programs intended to use signaling and their perceived impact of signaling on the residency interviewing process. Most program directors indicated that applicant signals would assist them in deciding who to invite for an interview and would be a positive factor in a holistic review process. However, program directors also noted that rotation experience or geographic ties would be more powerful inducements to interview or rank a specific candidate. Program directors did not indicate a belief that signals would decrease interview season stress or workload. Signals may play an important role in the residency application process for family medicine in 2023-2024. While signals are not anticipated to decrease application workload or stress, a signal may be an important mechanism for a specific applicant to distinguish themselves with a program.

Residency Applications in the Era of Generative Artificial Intelligence.

Residency Applications in the Era of Generative Artificial Intelligence.

Comparing Perceptions of Virtual and In-Person Interviews: Results From a National Survey of Internal Medicine Residents.

Background Since 2020, virtual interviews have become the typical way in which applicants assess residency programs. It is unknown whether the change from in-person to virtual interviews has been associated with changes in perceptions of the quality of information gathered by prospective applicants. Objective To ascertain perspectives on the satisfaction with, quality of, and accuracy of information gathered by internal medicine (IM) residency applicants from virtual and in-person interviews. Methods Twenty-nine thousand, seven hundred and seventy-six residents from US and Puerto Rico residency programs sitting for the 2022 American College of Physicians Internal Medicine In-Training Examination (IM-ITE) were surveyed. An optional, 5-question survey was administered at the end of the examination. Responses were analyzed based on interview format-virtual (postgraduate year [PGY]-1-2) or in-person (PGY-3)-and PGY. Results Of 29 776, 23 161 residents responded to the survey (77.8% response rate). Regardless of PGY, respondents reported a high degree of satisfaction with the quality of information gathered from their interview day, though there was a statistically significant difference between virtual and in-person [somewhat/very satisfied: In-person 5938 of 7410 (80.1%); 95% CI [79.2, 81.0] vs virtual 12 070 of 15 751 (76.6%); 95% CI [76.0, 77.3]:P<.001]. Residents in all PGYs reported sessions with residents and one-on-one interviews as the most important factors when creating their rank lists. Conclusions We found differences in satisfaction and perceptions of the quality of information gathered between IM residents who participated in virtual and in-person interviews. However, regardless of format, most respondents reported satisfaction with their interview experience.

Rescuelink: SOS Alert System for Disaster Response and Management

This study highlights the importance of such a system, given the absence of an effective platform that enables citizens to send SOS signals to emergency responders, leaving individuals without any response. This system provides web and mobile applications for residents, enables registered residents to send incident or emergency reports and communicate with the rescue team through a mobile app, and reduces response delays of the rescue team by getting an accurate location of the incident or emergency. The study used descriptive developmental research since it involves designing and developing the RESCUELINK: SOS System for Disaster Response and Management. Furthermore, it aims also to determine the acceptability of the system as evaluated by five (5) IT experts through the use of ISO/IEC 25010 based on the following characteristics: functional suitability, reliability, usability, efficiency, maintainability, portability, compatibility, and security. The RESCUELINK SOS System for Disaster Response and Management exhibits excellent performance across all evaluated ISO/IEC 25010 software quality characteristics, with an overall grand mean score of 4.66. Implementing this system in Silay City is expected to improve the efficiency and effectiveness of the DRRM operations significantly.

Dear Program Director: An Evaluation of Implicit Bias in Letters of Recommendation for Neurosurgery Residency.

Despite comprising half of medical students, women represent only 29.6% of neurosurgery applicants and 17% of residents, suggesting a "leak" in the career pipeline for women neurosurgeons. Surveys persistently show that neurosurgery programs identify United States Medical Licensing Examination (USMLE®) Step 1 score and letters of recommendation (LORs) as the most important factors in selecting applicants to interview. A previous study in neurosurgery found no differences in LORs. However, multiple studies in other specialties have demonstrated implicit gender bias in LORs, which may influence resident selection. Our objective is to evaluate neurosurgery residency LORs for evidence of implicit gender bias. Retrospective analysis of LORs for interviewed neurosurgery applicants at a single institution during the 2014 to 2020 National Residency Matching Program (NRMP®) match cycles. Letters were evaluated using Linguistic Inquiry & Word Count (LIWC) software (Pennebaker Conglomerates), and additional applicant data were obtained from candidate applications. LIWC (Pennebaker Conglomerates) output data included custom dictionary categories and terms that were analyzed using Prism 10 and Rstudio. Two hundred eighteen applications were reviewed for a total of 827 letters. LIWC (Pennebaker Conglomerates) analysis showed significant differences in word count (331 vs 297, difference = 34, 95% CI: 9-61, P = .008). LORs for applicants who were men were more likely to mention Alpha Omega Alpha Honor Medical Society (1.17 vs 0.778, difference = 0.4, 95% CI: 0.13-0.67, P = .023). USMLE® Step 1 scores were significantly lower for women (241 vs 247, difference = 6, 95% CI: 2-10, P = .004). There was no significant difference between letters for men and women for all categories evaluated in the linguistic evaluation. LORs are vital to the neurosurgical residency application process. The data exhibit some differences between the men and women applicants but few differences in their LORs, consistent with the results of the previous neurosurgical study.

Concerns of osteopathic medical students during the COVID-19 pandemic.

This study aims to quantify the areas of most concern in medical students in relation to their residency application in the setting of the COVID-19 pandemic and to identify risk factors for all that cause concern and specific areas of concern in a population with well-established high rates of anxiety at baseline. The COVID-19 pandemic introduced sweeping changes to medical education that had wide-ranging effects on medical students and their applications for medical residencies. In August 2020, we utilized a cross-sectional study to quantify student's areas of concern related to residency application related to the COVID-19 pandemic. We asked participants to rate their levels of concern in 15 different aspects related to medical residency applications and the perceived impact that COVID-19 had on each. The survey was distributed to 984 osteopathic medical students, with 255 complete responses. The three areas of greatest impact were shadowing opportunities (4.15), volunteer opportunities (4.09), and conferencing opportunities (4.09). The most salient demographic variables were year in school, sex, and locale. Females reported higher levels of concern across all categories in the study compared to males, with statistical significance across all categories (all p<0.05, Range d=0.16 to 0.43), except for letters of recommendation and sub-internships. The areas of most concern identified in our study were consistent with prior studies and may implicate the pressures that female medical students may feel compared to their male counterparts. The underlying cause(s) may be subject to future research.

Gender Bias in Artificial Intelligence-Written Letters of Reference.

Letters of reference (LORs) play an important role in postgraduate residency applications. Human-written LORs have been shown to carry implicit gender bias, such as using more agentic versus communal words for men, and more frequent doubt-raisers and references to appearance and personal life for women. This can result in inequitable access to residency opportunities for women. Given the known gendered language often unconsciously inserted into human-written LORs, we sought to identify whether LORs generated by artificial intelligence exhibit gender bias. Observational study. Multicenter academic collaboration. Prompts describing identical men and women applying for Otolaryngology residency positions were created and provided to ChatGPT to generate LORs. These letters were analyzed using a gender-bias calculator which assesses the proportion of male- versus female-associated words. Regardless of the gender, school, research, or other activities, all LORs generated by ChatGPT showed a bias towardmale-associated words. There was no significant difference between the percentage of male-biased words in letters written for women versus men (39.15 vs37.85, P = .77). There were significant differences in gender bias found by each of the other discrete variables (school, research, and other activities) chosen. While ChatGPT-generated LORs all showed a male bias in the language used, there was no gender bias difference in letters produced using traditionally masculine versus feminine names and pronouns. Other variables did induce gendered language, however. ChatGPT is a promising tool for LOR drafting, but users must be aware of potential biases introduced or propagated through these technologies.

Predictors of Plastic Surgery Applicant Success: An Analysis of the Texas STAR Database.

Integrated plastic surgery residency is one of the most competitive medical specialties. Although previous studies have surveyed integrated plastic surgery residency program directors regarding desired applicant characteristics, there is a paucity of literature assessing detailed application characteristics and reported match outcomes from applicants in recent application cycles. This study examines application characteristics associated with matching into integrated plastic surgery residency from 2017 to 2023. The authors accessed the Texas Seeking Transparency in Application to Residency database, which contains survey information from graduating medical students nationwide regarding residency application characteristics and specialties/programs to which applications were submitted. Characteristics of matched versus unmatched applicants between 2017 and 2023 were compared using χ 2 and 2-sided, independent t tests. Univariate logistic regression models were used to assess predictors of a successful match. A total of 381 integrated plastic surgery residency applicants responded to the Texas Seeking Transparency in Application to Residency survey from 2017 to 2023. Mean United States Medical Licensing Exam Step 2 CK scores; the number of away rotations, interview offers, and honored clerkships; and Alpha Omega Alpha membership rate were significantly associated with and predictive of matching. Preference signaling of programs was associated with an increased interview offer rate. Higher board examination scores, increasing numbers of honored clerkships, away rotations, and Alpha Omega Alpha membership were identified as statistically significant predictors of matching into integrated plastic surgery residency. Prospective applicants should use this information to help guide their efforts in these areas that appear to be associated with a successful transition to residency.

Importance of abortion training to United States Obstetrics and Gynecology residency applicants in 2023

ObjectiveNearly half of obstetrics and gynecology (OB/GYN) residency programs in the United States lost access to local training in abortion care following the 2022 Dobbs v Jackson Supreme Court decision. We aimed to determine whether OB/GYN residency candidates who desire abortion training apply to programs in states where abortion is restricted/banned. Study designIn 2023, we conducted an anonymous electronic survey of residency interviewees at three large academic OB/GYN programs about the importance of various program characteristics in their selection process. We chose to represent both very restrictive and protective environments for abortion care. We stratified respondents by importance of abortion training in applying to programs (essential or very important [high preference group] vs moderately, slightly, or not important [low preference group]). ResultsWe analyzed 175 completed surveys (response rate 56%). Of 175 respondents, most (n = 115, 66%) stated that access to abortion training was essential (33%) or very important (33%) when applying to programs. Both high preference group (82%) and low preference group respondents (98%) applied in states where abortion is banned or restricted. Respondents applied in banned/restricted states due to geography, concern about applying to too few programs, and expectation that the program would provide out-of-state training nonetheless. ConclusionThe majority of survey respondents who reported that access to abortion training during residency is essential or very important applied to programs where abortion training is not locally available. Most of these applicants expected programs in restricted states to provide training regardless. ImplicationsResidency programs should be aware of the importance of abortion training to applicants, as well as abortion training expectations, and work to develop opportunities and strengthen training networks in abortion care to meet candidates’ needs and ensure adequate learning opportunities exist for all.

Return on Investment of Three-Year Accelerated Programs for Students, Medical Schools, Departments, and Community

Building on the initial accelerated pathway programs in the 1970s to increase workforce, nearly 30 schools have launched accelerated 3-year pathways (A3YP) during the past decade. The authors based on their educational roles, experiences, and scholarship with A3YP provide this perspective of the argument for A3YP and potential disadvantages for each group—students, schools, residencies, departments, and community. When schools consider innovations, they might consider A3YPs for multiple reasons; this perspective helps provide justification for the program and broadly considers return on investment (ROI). The ROI for students includes decreased debt, reduced costs and stress associated with the fourth-year residency applications, and a directed pathway with facilitated transition into a residency program with accompanying professional identity development. Disadvantages for students include early specialty commitment, risk of deceleration, and condensed curriculum. The ROI for schools includes recruiting and retaining students, who will then transition more easily into residency and stimulating innovation. Residency programs gain residents with known skills, who have been a part of the department for 3 years. In addition, fewer residency slots for interviewing leads to saving recruitment administrative costs and time. Finally, many programs are intended to increase the workforce, since students who come to the region for medical school and transition directly into residency are likely to stay in the region. Disadvantages include increased curricular complexity for the medical school, increased administrative support, and advising resources. Finally, several of the accelerated programs attract matriculants from diverse backgrounds contributing to the diversity of the medical school, residency program, and community workforce.

Effect of Dobbs v. Jackson Women's Health on Obstetrics and Gynecology Residency Applicants [ID 2683390

INTRODUCTION: Abortion restrictions affect not only provision of abortion care but also experience for trainees. Data from the 2023 match showed a decrease in obstetrics and gynecology residency applications in restrictive states. Our national survey of medical students applying to obstetrics and gynecology residency sought to assess the effects of the Dobbs decision on their application process. METHODS: Medical students who applied to obstetrics and gynecology residency for the 2023 match were surveyed via an electronic questionnaire. Convenience sampling was used. Institutional review board waiver was granted. RESULTS: One hundred seventy-eight students, from 39 different states, completed the survey. The average age was 27.8 years, and the majority identified as women (89%) and White (80.9%). The majority (72.7%) of respondents reported that the Dobbs decision influenced which residency programs they applied to, and of those, 96.9% report that they applied to programs in states with fewer abortion restrictions. Similarly, 66.5% reported that the decision influenced their rank list, and of those, 98.3% report they ranked programs in states that are less restrictive on abortion services higher. CONCLUSION: Access to abortion training was identified as important to a majority of survey respondents. Students reported applying to states with less abortion restrictions and that access to abortion training influenced their rank list. Prior studies have surveyed third- and fourth-year students about predicted effects of the Dobbs decision on residency applications. This is the first to assess perspectives among students who completed the residency application process.

Experience From an Early Exposure Education Program in Radiation Oncology for High School and Undergraduate Students

Exposure to radiation oncology (RO), which is a small and highly subspecialized field of oncology, during undergraduate or medical education is often limited. Coupled with reduced elective exposures during the COVID-19 pandemic, unsubstantiated concerns regarding the RO job market have led to a noticeable decline in residency applications and medical students who express an interest in the field. Here, we describe a summer education program piloted in our RO department at a comprehensive cancer center to provide premedical school students (ranging from high school to postbaccalaureate) early exposure to the specialty through clinical shadowing, research opportunities, journal club, and formal didactic lectures. Pre- and postprogram surveys were administered to these students to evaluate the change in knowledge in RO. A total of 8 students participated in the program. We found an increase in understanding of the specialty, high levels of interest in considering RO as a career, and positive feedback regarding the program overall. This study supports the role of early exposure and education in stimulating interest in future medical students to pursue RO as a career. Future efforts are needed to further develop and evaluate these education programs as well as disseminate the program more broadly.

Applicant Use of Residency Program Websites During Virtual Interviews [ID 2683623

INTRODUCTION: Program websites are the most common online resource applicants use to access information about residency programs. During the COVID-19 pandemic, online resources have had to take place of site visits when interviews transitioned to the virtual setting. At this time, the Accreditation Council for Graduate Medical Education does not have a plan for a transition back to in-person interviews. The objective of this study is to assess applicant use, and information that is sought for development of high-quality residency websites. METHODS: A survey was shared to interviewees on their interview day with Creighton University–Phoenix obstetrics and gynecology residency during the 2022–2023 application cycle. To remove the possibility of influence or coercion, the survey was kept anonymous. This was found to be IRB exempt. RESULTS: Of the 88 survey respondents, 100% marked they visited the program website. Only 32 of the 88 respondents indicated they did not find the information they were looking. The most-sought information by respondents was current resident profiles (75% of respondents), hospital/training site information (68%), rotation schedule (63%), and faculty profiles (60%). Other notable categories respondents were hoping to find information about included the following: surgical training, family planning training, and benefits offered by the program. CONCLUSION: Program websites are highly utilized by residency applicants. Information traditionally shared on interview day is now found through online resources; most-sought information included resident and faculty profiles, rotation schedules, and training site information.

Trends and Predictors of Cost in the Obstetrics and Gynecology Residency Application Process [ID 2683644

INTRODUCTION: Travel restrictions from the COVID-19 pandemic required residency programs to transition from an in-person to virtual interview process. Obtaining an obstetrics and gynecology residency position is known to be competitive and places a considerable financial burden on applicants. This study aims to quantify the total costs in the application process before and after virtual interviews were implemented. METHODS: The Texas STAR database was queried to identify obstetrics and gynecology residency applicants from 2019 to 2023. The primary outcome was applicant-reported spending on the residency application process. Descriptive statistics and linear regression models were used to evaluate for associations with sociodemographic, temporal, and geographic factors. RESULTS: A total of 2,315 obstetrics and gynecology applicants were included. Applicants reported significantly less average total spending on the residency application process after the start of the COVID-19 pandemic compared to the years prior ($2,515 [SD 2,055] versus $4,909 [SD 2,869]; P&lt;.001). Applicants who identified as underrepresented in medicine (P=.022), had a DO degree (P&lt;.001), completed a research year (P=.030), participated in the couples match (P&lt;.001), or were from the Western region (P&lt;.001) reported significantly more total spending. There was a significant positive correlation between total non-interview-related spending and the number of interviews received (P&lt;.001). CONCLUSION: There was a significant reduction in applicant spending after the start of the COVID-19 pandemic, likely related to transition to virtual interviews and limitations on in-person away rotations. The association of applicant spending with the number of interview offers raises concern for possible equity implications.

The Year in Graduate Medical Education: Selected Highlights from 2023

This special article is the third in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia that highlights significant literature from the world of graduate medical education that was published over the past year. Some of the major themes that will be addressed in this review include the potential uses and pitfalls of artificial intelligence in graduate medical education, trainee well-being and the rise of unionized house staff, the effect of gender and race/ethnicity on residency application and attrition rates, and the adoption of novel technologies in medical simulation and education. The authors would like to thank the editorial board for again allowing us to draw attention to some of the more interesting work published in the field of graduate medical education during 2023. We hope that the readers find these highlights thought-provoking and informative as we all strive to successfully educate the next generation of anesthesiologists.

Student Perspectives on the Undergraduate Medical Student Research Experience at a Single United States Allopathic Institution.

Introduction The purpose of this study was to identify student-reported institutional facilitators and barriers to successful research experiences at a single United States allopathic institution. Residency applications have increasingly become more competitive, and with the United States Medical Licensing Examination (USMLE) Step 1 exam's transition to pass/fail, factors such as research experience and outcomes may become more important to increase residency application competitiveness. This study sought to explore factors that impact successful research experiences leading to tangible outcomes for medical students at our medical school, the Joe R. & Teresa Lozano Long School of Medicine. Methods A cross-sectional survey was developed and administered via REDCap to 853 students in May 2022. Survey question domains included demographics, past and present research participation, perceived barriers/facilitators to research, tangible outcomes (e.g., publications and posters), and overall satisfaction with research comparing subjectively "best" and "worst" experiences. The Institutional Review Board (IRB) deemed this project as non-regulated research. Results We had a 24% (n = 204/853) response rate. The responses were distributed equally among the four classes. A big portion of the participants (71%, n = 59/83) identified a tangible outcome as the most important measure of success. Regarding facilitators, students identified having a mentor (89%, n = 165/184) and departmental connections (85%, n = 156/184) as the most important when looking for a project. Barriers included SMART goals (Specific, Measurable, Achievable, Relevant, and Time-Bound) lacking in 31% (n = 24/75) of worst projects, followed by a clear timeline in 29% (n = 22/76) and hours of commitment in 27% (n = 21/78). The best projects were more likely to have resulted in a publication (61% (27/44) vs. 32% (14/44)) or have a poster (64% (28/44) vs. 36% (16/44)). Conclusions Medical students are interested in participating in research, with important facilitators including mentorship and departmental connections. Modifiable variables include lack of clear timelines, well-defined roles and responsibilities, and time commitments. This information may be useful for faculty who mentor medical students or medical schools interested in designing medical student research programs.

Barriers to neurosurgery for medical students: a national study focused on the intersectionality of gender and race.

Despite 51.2% of medical school graduates being female, only 29.8% of neurosurgery residency applicants are female. Furthermore, only 12.6% of neurosurgery applicants identify as underrepresented in medicine (URM). Evaluating the entry barriers for female and URM students is crucial in promoting the equity and diversity of the neurosurgical workforce. The objective of this study was to evaluate barriers to neurosurgery for medical students while considering the interaction between gender and race. A Qualtrics survey was distributed widely to US medical students, assessing 14 factors of hesitancy toward neurosurgery. Likert scale responses, representing statement agreeability, converted to numeric values on a 7-point scale were analyzed by Mann-Whitney U-test and ANOVA comparisons with Bonferroni correction. Of 540 respondents, 68.7% were female and 22.6% were URM. There were 22.6% male non-URM, 7.4% male URM, 53.5% female non-URM, and 15.2% female URM respondents. The predominant reasons for hesitancy toward neurosurgery included work/life integration, length of training, competitiveness of residency position, and perceived malignancy of the field. Females were more hesitant toward neurosurgery due to maternity/paternity needs (p = 0.005), the absence of seeing people like them in the field (p < 0.001), and opportunities to pursue health equity work (p < 0.001). Females were more likely to have difficulties finding a mentor in neurosurgery who represented their identities (p = 0.017). URM students were more hesitant toward neurosurgery due to not seeing people like them in the field (p < 0.001). Subanalysis revealed that when students were stratified by both gender and URM status, there were more reasons for hesitancy toward neurosurgery that had significant differences between groups (male URM, male non-URM, female URM, and female non-URM students), suggesting the importance of intersectionality in this analysis. The authors highlight the implications of gender and racial diversity in the neurosurgical workforce on medical student interest and recruitment. Their findings suggest the importance of actively working to address these barriers, including 1) maternity/paternity policy reevaluation, standardization, and dissemination; and 2) actively providing resources for the creation of mentorship relationships for both women and URM students in an effort to create a workforce that aligns with the changing demographics of medical graduates to continue to improve diversity in neurosurgery.

D66. Linguistic Analysis of Race and Gender Bias in Narrative Letters of Recommendation for Plastic Surgery Residency Applicants

D66. Linguistic Analysis of Race and Gender Bias in Narrative Letters of Recommendation for Plastic Surgery Residency Applicants

Virtual Interviews: The Format of the Future [ID 2683645

INTRODUCTION: Residency interviews have transitioned from an in-person to a virtual format during the COVID-19 pandemic. Virtual interviews have helped applicants reduce spending costs, time, and greenhouse gas emissions related to travel. This study aims to assess the preferences of obstetrics and gynecology applicants in continuing a virtual format for residency interviews. METHODS: The Texas STAR database was queried for obstetrics and gynecology applicants who responded to “I would be in favor of continuing virtual interviews going forward” on a 5-item Likert scale from 2021 to 2023. Descriptive statistics (chi-square and ANOVA) were used to evaluate trends in responses over time and associations with applicant characteristics. RESULTS: A total of 1,348 obstetrics and gynecology applicants responded to the survey, among whom 924 (68.5%) agreed or strongly agreed that they would favor continuation of virtual interviews. The percentage of applicants who favored virtual interviews significantly increased each year (55.1% in 2021, 68.7% in 2022, and 81.1% in 2023; P&lt;.001). Applicants who reported higher total spending on the residency application process were more likely to favor virtual interviews (mean [SD]: $2,637 [2,243] versus $2,240 [1,550]; P=.001). There were no significant differences in sex, race, or geographic region in applicants who favored virtual interviews compared to those who did not favor or were undecided. CONCLUSION: The majority of obstetrics and gynecology applicants favor continuation of virtual interviews, and this trend has been increasing each year. There do not appear to be any sociodemographic differences between applicants who do and do not favor virtual interviews.

A Novel Residency Application for Obstetrics and Gynecology

A Novel Residency Application for Obstetrics and Gynecology