Unmatched Students Research Articles

Influence of the Number, Timing, and Types of Advanced Pharmacy Practice Experiences on Residency Matching

ObjectiveTo characterize the association between the number, timing, and type of Advanced Pharmacy Practice Experiences (APPEs) and the likelihood of postgraduate year 1 (PGY1) residency match outcomes. MethodsA retrospective cohort study was performed among PGY1 residency-seeking pharmacy students from graduating years 2018–2021 as identified from the National Matching Services Inc enrollee list. The number of APPEs of interest (AOI) most likely to align with general PGY1 residencies (acute care, ambulatory care, and elective rotations with significant direct patient care interactions) completed before January of the respective graduation year (GY) was compared between matched and unmatched students to a PGY1 program in any phase. Classification and regression tree analyses were performed to identify the AOI threshold associated with an increased likelihood of matching. ResultsAmong 155 students meeting inclusion criteria, 115 students (74%) matched during the study period. The probability of matching was 36%, 74%, and 83% for students completing 2, 3 or 4 AOI, respectively. Classification and regression tree analyses identified 3 or more AOI completed before January of the GY as the threshold significantly associated with PGY1 residency matching. ConclusionCompleting at least 3 AOI before January of the GY was associated with a significantly increased probability of PGY1 residency matching. These findings may influence students’ preferences for sequencing of APPEs to improve match results, but may be limited by institutional capacity.

The Fate of the Unmatched Urology Applicant

ObjectiveTo determine the outcomes and eventual career paths for unmatched applicants by evaluating a historical cohort of unmatched applicants in the Urology Match. MethodsThe 2008-2014 AUA Match lists were obtained from the Society of Academic Urologists and 730 unique applicants were identified with at least one unmatched result. Additional information such as preliminary training and eventual specialty choice were obtained from publicly available sources. Comparative analysis with univariable and multivariable analysis was performed between eventual urologists and those who chose alternative career paths. ResultsOverall, 43.5% (318/730) of unmatched urology applicants subsequently continued their interest in Urology and 77.4% (246/317) of initially unsuccessful applicants eventually became urologists. Males (80.9%, P = .01), Doctor of Osteopathy (DO) degree (62.5%, P = <.001), and those undergoing a research year compared to a preliminary surgery year (85.2% vs 72.0% respectively, P = .047) had an increased likelihood of successfully becoming a urologist. The most common alternative specialty choices were Internal Medicine (13.8%), General Surgery (12.9%) and Anesthesiology (11.9%). ConclusionUrology is a competitive surgical sub-specialty. Surprisingly, approximately 3 in 4 unmatched urology applicants who continue their interest in urology will eventually obtain a residency position. However, only 33.7% of initially unmatched students ultimately became urologists. Unmatched applicants have several viable pathways to obtain a urological residency position. Male gender, a DO degree, and a research year are associated with successfully obtaining a urology residency position.

Analysis of Twitter Engagement in a Progressively More Competitive Urology Match: A Mixed Methods Study

ObjectiveTo analyze Twitter engagement in response to the urology match during the COVID-19 pandemic. MethodsTweets containing the hashtags “#uromatch” or “#AUAmatch” during the 2021 and 2022 Match Week were reviewed. Date, author type and number of followers, general content, and engagement with each Tweet was collected. Differences in engagement between author type and content were analyzed using the Kruskal-Wallis H test. Tweet characteristics were compared between the 2021 and 2022 Match Cycles using the Chi-Square test. ResultsThere were 656 Tweets in total, with 272 (43.5%) from 2021 and 353 (56.5%) from 2022. Medical students’ and residency programs’ posts received significantly more Tweet engagement than those by residents/fellows, attendings, or the AUA (P <.05). Tweets focusing on announcing a new residency class and personal announcements of match results received significantly more engagements than other content categories (P <.05). In 2022, there was a significantly higher percentage of Tweets about advice for unmatched applicants (2.2 vs 12.5; P <.001), match statistics (0.4 vs 2.9; P = .028) and focus on underrepresented groups in urology (0.7 vs 3.4; P = .029). ConclusionThe Twitter response to the urology match between 2021 and 2022 mirrored the increase in competitiveness, with greater participation and an increasing focus on the difficulty of matching. During Match Week, Twitter is a readily available source of information for programs, matched students, and unmatched students alike. As we continue to embrace virtual platforms, we believe that Twitter will remain a major source of match-related information and can be an instrumental tool for broader networking in our field.

"We regret to inform you that you did not match": Reflections on how to improve the match experience.

There is increasing concern amongst stakeholders over the high numbers of unmatched Canadian Medical Graduates (CMGs), yet little is known from the perspective of those who go unmatched. We present an opinion-based narrative analysis examining the matching process by reflecting on the pre- and post-match period and provide suggestions related to the Canadian context from the unmatched perspective. The challenge in the pre-match period was a lack of transparency around elective availability, resident selection criteria, and what happens after going unmatched. For the post-matched period, we were challenged with decision-making during a time-sensitive period, scheduling post-match electives, handling our finances, and improving our future residency applications without feedback. We have tried to identify the most impactful issues we encountered as applicants and unmatched students, and offered suggestions to improve the applicant experience. In addition to sharing our reflection in going unmatched, we also highlight the positive side of this formative experience.

A tale of two curricula: Learning and matching in the final year of medical school.

In this article, I highlight two curricula that I believe are most prominent during the final year of the Canadian medical school experience—that of learning and that of matching to residency. While these two curricula are not mutually exclusive, they can be perceived as conflicting by learners who shift their focus away from learning towards performing in an effort to optimize their chance of matching to their program of choice. Moreover, the higher rates of unmatched students in recent years have likely contributed to this shift while at the same time bringing more stress and anxiety into the lives of medical students. I argue that there needs to be curricular consistency among all stakeholders including undergraduate programs, postgraduate programs, and other third-party organizations.

Relationship Between Institutional Standardized Letter of Evaluation Global Assessment Ranking Practices, Interviewing Practices, and Medical Student Outcomes

Emergency medicine (EM) program directors rely largely on the standardized letter of evaluation (SLOE) to help determine which applicants to interview in the face of an increasing number of applications. To further characterize the SLOE's role in the EM application process, particularly the global assessment (GA) ranking and its effect on interviewing practices and medical student outcomes, the leaders of EM programs were surveyed regarding their experiences in both generating and utilizing the SLOE. Individuals on the Council of Emergency Medicine Residency Directors (CORD) and Clerkship Directors in Emergency Medicine (CDEM) Academy listservs were anonymously surveyed from March 21-30, 2015, with 18 questions in multiple-choice and fill-in-the-blank formats. There were 99 respondents. Only 39 respondents (39%) reported adhering strictly to SLOE guidelines by evenly placing their students into thirds (top, middle, lower) on the SLOE GA. Most respondents interviewed individuals ranked in the lower third. Programs adhering strictly to ranking guidelines were more likely to interview students in the lower third than those adhering loosely or not at all. There was no relationship between a program's self-reported adherence to the SLOE ranking guidelines and the number of unmatched students in EM during the 2014 and 2015 academic years. Many SLOE writers do not strictly adhere to CORD's SLOE writing guidelines when using the GA ranking, due to the fear of adversely impacting an applicant's ability to successfully match into EM. This calls into question the validity of the SLOE as it is currently used. However, this study suggests that adhering to recommended SLOE ranking guidelines is unlikely to substantially increase the risk that students will fail to match. If more evaluators were to adhere to the guidelines, the SLOE could become the valid evaluation instrument that graduate medical education has long been pursuing.

Considerations for Medical Students and Advisors After an Unsuccessful Match.

Increasing numbers of graduating U.S. medical students are not securing a graduate medical education (GME) position, even after participating in the National Resident Matching Program (also known as "the Match") and the Supplemental Offer and Acceptance Program. The reasons for an unsuccessful Match include increasing numbers of applicants compared with nearly unchanging numbers of available GME positions, academic problems or professionalism lapses, and a poor fit between applicants and their first-choice specialty.In this Perspective, the authors (1) examine the current Match landscape; (2) discuss the environmental factors that affect that Match landscape such as increasing medical school enrollment without a corresponding increase in GME positions; (3) review historical data on unmatched MD students; (4) discuss medical schools' responsibilities to unmatched students and to society; (5) explore controversial issues related to unmatched students, including graduation delays and altering the Medical Student Performance Evaluation for subsequent Match applications; and (6) outline various pathways for unmatched students to secure a GME position in the future or to pursue an alternative, nonclinical position. Finally, they share guidelines for advising unmatched students in the weeks and months following an unsuccessful Match. These recommendations aim to clarify what options exist, and are practical, for unmatched students, with the hope that further study will enable the development of best practices in this area.

Survey of pharmacy schools to determine methods of preparation and promotion of postgraduate residency training

ObjectiveTo identify the means in which pharmacy schools promote postgraduate residency training and prepare their students to be competitive candidates for such programs. MethodsAn electronic survey was e-mailed to administrators of pharmacy schools who were fully accredited by the Accreditation Council for Pharmacy Education (ACPE) as of January 2014. The pre-tested survey included a possible 28 questions and employed skip logic to guide respondents. Formal activities available to students regarding promotion of and preparation for postgraduate residency opportunities as well as the extent to which pharmacy schools assist unmatched students in obtaining pharmacy residency positions was summarized via descriptive statistics of frequencies and averages. ResultsOverall, 63 pharmacy schools were represented of all 114 ACPE-accredited pharmacy schools surveyed in January 2014 (55.3% response rate). In all, 36 schools (57.1%) offered an elective course and 26 schools (41.3%) offered 40 curricular tracks whose purposes were to prepare students to be competitive candidates for postgraduate residency training or advanced direct patient care roles (beyond what is required of all students). The three most commonly used methods to promote and prepare students for postgraduate residency training were lectures, residency showcases, and programming via student organizations. More than 75% of schools offered at least some type of advising on and after residency Match Day. ConclusionA variety of methods to promote and prepare students for residency training was reported. General academic advising and advising for unmatched residency candidates was found to not be standardized. Pharmacy schools need to develop systematic methods for preparing students.

The Internship Imbalance in Professional Psychology: Current Status and Future Prospects

The internship is an essential part of doctoral training in professional psychology. Most students access internships through the annual match sponsored by the Association of Psychology Postdoctoral and Internship Centers (APPIC). For two decades the match has seen an increasing shortfall of internship positions relative to applicants, exceeding 650 unmatched clinical students as of 2013. Efforts to solve this problem have not met appreciable success. This review discusses the structure of the internship placement process, including and beyond the APPIC match, and identifies the reasons for the failed efforts, which lie principally in the varied standards for an acceptable internship among doctoral programs. Efforts to establish a common standard and the need for a governance structure to enforce whatever standard is agreed upon are discussed. Projections for the future of the placement process and the imbalance are sketched, and links to other issues in the field are briefly reviewed.

How Should Unmatched Orthopaedic Surgery Applicants Proceed?

Obtaining an orthopaedic surgery residency is competitive. Advisors must understand what factors may help unmatched candidates reapply successfully. We determined (1) the attitude of leaders of orthopaedic surgery residency programs toward interviewing unmatched students; (2) whether a surgical internship or a research year is preferred in considering reapplicants; (3) the importance of United States Medical Licensing Examination (USMLE) scores, recommendations, and Alpha Omega Alpha (AOA) membership; and (4) whether academic and nonacademic programs evaluate reapplicants differently. We sent an anonymous 19-question survey to 151 Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery residency programs in five waves, 1week apart (December 5, 2009-January 5, 2010). Investigators were blinded to the respondents' identities. Ninety-one of the 151 programs (60%) responded. Sixty-eight of the 91 programs (75%) stated they rarely accept unmatched applicants. Sixty-eight programs (75%) agreed an unmatched applicant should do a surgery internship for 1year. Of the 36 programs that recommended a research year, 32 were academic programs. Academic programs were more likely than nonacademic programs to view as important new recommendations (85% versus 67%), minimum scores of 220 on Step I (67% versus 49%) and Step II (64% versus 36%), and AOA membership (85% versus 67%). By completing a surgical internship, unmatched students may increase their chances of matching. Students considering academic programs should ensure their academic record meets certain benchmarks and may consider a research year but risk limiting their acceptance to academic programs.

How competitive is my surgical specialty?

Background: It is difficult to determine relative competitiveness of surgical training positions: there is no single source for matching process results and specialty-specific competitiveness may change over time. This study was undertaken to address these issues. Methods: Numbers of matched/unmatched students and positions offered/filled for surgical specialties were analyzed for specialty-specific trends in match rates and differences among specialty match rates over time. Results: From 1996 to 2000, match rates increased for neurological surgery, general surgery and otolaryngology; decreased for ophthalmology and urology and were unchanged for orthopedic surgery. Although the “most competitive” and “least competitive” specialties changed each year, unmatched student numbers uniformly exceeded unfilled position numbers. Conclusions: Match rates changed over time; no single specialty was consistently most or least competitive. Unmatched students were unlikely to successfully “scramble” for an advanced/categorical training position in any surgical specialty because of the uniformly very high fill rates.

DPD Directors’ Perceptions of the Impact of Failure of Students to Secure Dietetic Internships

The experiences and perception of DPD directors regarding the inability of graduates to secure a position in a dietetic internship upon graduation were assessed through a 31 item survey using e-mail (where possible), FAX, or mail transmission. The survey included three sections: the impact of having unplaced students, the directors’ opinions of strategies that might increase the likelihood of placement and of ways to limit the negative impact on unmatched students, and report of policies implemented in the director's own DPD. All 229 directors listed in the ADA Directory of Dietetic Programs were sent surveys with follow-up reminders as needed; 44% of the surveys were returned. Directors considered failure to secure internships as a significant problem (65% agreeing); major aspects of the problem being a negative impact on the DPD's reputation (64%) and unplaced students experiencing difficulties in finding employment shortly after graduation (53%). Directors (61%) agreed that it would be effective to use a GPA standard for retention in the program, but only 21% reported such a policy in their DPD. Relevant to this discrepancy are the facts that 72% felt that limiting enrollment infringed upon student rights and that 65% felt that the resulting low enrollment would jeopardize the program. Most directors (75%) reported advising weak students to change their majors, but only 12% agreed that only academically-excellent individuals should practice dietetics. Program actions that were scored as helpful were supportive and empathetic advisement (76%), assistance in maintaining self esteem (69%), coaching on application and interview skills (61%), and emphasis on early and complete understanding of the competitive nature of internship placement (59%). Less than 18% reported providing any special opportunities for students not likely to be matched. Recommended advice for unmatched students was to work for a while and reapply (89%), to go to graduate school and re-apply (64%), or to go into foodservice management (62%). Comments indicated a high level of frustration with the situation. There was no evidence that DPD size was a factor in the responses.

Recommendations for changing the residency selection process based on a survey of program directors.

The authors conducted a nationwide survey of program directors participating in the 1990-91 National Resident Matching Program (NRMP) in order to solicit the directors' responses to elements of the current residency selection process and to suggested revisions. Of 680 randomly selected directors, 469 (69%) responded to the survey questionnaire, using a five-point scale, from 1, indicating strong agreement, to 5, indicating strong disagreement. The directors agreed that the senior year was distorted by the selection process, that students were pressured into making early career decisions, and that there needed to be more structure to the senior year. The directors were also in agreement that interviews, the NRMP, and the uniform notification date were working well. But deans' letters, other letters of recommendation, the Universal Application, and appointment of unmatched students were considered to be in need of improvement. The development of a centralized residency application service with the electronic transmission of data received the directors' support. The authors recommend that a task force be convened to consider changes that would improve the selection process and would reduce disruption of the students' senior year of medical education.

Characteristics of graduating medical students who were matched and unmatched to hospital training posts.

The purpose of this paper is to examine similarities and differences between graduating medical students who do and do not match through the National Internship and Resident Matching Programme (NIRMP). Data from graduates of 3- and 4-year undergraduate curricula were examined separately. A two way analysis of variance was used; the two independent variables were (1) whether the student was a 3- or 4-year medical graduate, and (2) the students' matched vs unmatched status. The dependent variables used in this study were in the following five categories: (1) demographic and academic performance upon entrance to medical school, (2) academic performance during medical school, (3) future practice preferences projected during medical school, (4) internship/residency choices, and (5) clinical performance during internship/residency. On the basis of the data presented, it is clear that there are few differences between matched and unmatched students that could be detected in over seventy-five measures examined. Within the unmatched group, however, the 3-year graduates differ in some respects from their 4-year colleagues. It is likely, therefore, that a different constellation of factors appears to be operating in these two unmatched groups but not within the matched groups.