Abstract
We read with great interest the study by Newsome et al, 1 in which the authors analyzed residency match and rank order list (ROL) data, in order to assess temporal trends in ROL lengths for both matched and unmatched residency applicants and osteopathic (DO) and allopathic (MD) medical programs. The authors maintain that although both applicants and programs over the last 7 residency match cycles have been submitting significantly longer ROLs, fewer applicants were matching at their preferred programs. Given the increasing controversy surrounding this topic, we thank the authors for their timely investigation and would like to take the opportunity to raise some additional insights into the implications of a congested Match cycle.
Newsome et al 1 are in agreement that a congested Match has serious implications on applicants of lower socioeconomic status due to the financial strain one is put under to keep up with the need for an increasing ROL. In addition to this, we believe attention should be directed toward the systematics of program visiting rotations, an integral component of applications for most. The completion of an away rotation can spark interest in applicants regarding specialty options as well as providing valuable insight into whether a specific field or program is the right fit for them. However, despite their benefits, the bleak reality is that there is significant financial hardship created by away rotations, which may dissuade students from lower socioeconomic status from applying to as many programs as they would hope to, if any at all. Access to such opportunities have become limited to the select few that have the financial capabilities to participate, which raises concerns regarding how the Match and its selection processes take into account circumstantial factors to create an even playing field for all. Furthermore, the authors stipulate that unmatched applicants tended to have lower United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores which could prove to be a setback in the face of an increasingly competitive and overcrowded Match. We believe that the more recent transition of USMLE Step 1 to pass/fail (P/F) should also be accounted for when an application is under consideration. While those attending traditional, highly ranked MD programs may benefit from this change, students from non-traditional routes of medicine such as DO or international programs may be negatively impact as the Step 1 score used to act as a standardized way of academic assessment. 2
To help combat this, programs involved in the Match may consider working to improve the standardization of their application process with regard to socioeconomic status, Step 1 and 2 scores, and access to opportunities to allow for a more holistic review of applicants. To address inequities concerning away rotations, some institutions have also worked to offer stipends to students from lower socioeconomic brackets and place caps on the number of away rotations a single applicant may apply for. 3 Additionally, for programs that guarantee interviews to students who complete a visiting rotation, program directors may consider offering students the option to interview at the conclusion of their rotation, rather than return for a later interview to curtail some of the costs of residency applications. Newsome et al discussed the use of virtual interviews in their discussions, suggesting that they may create problems for both applicants and program directors. Interestingly, a recent survey administered to radiology residency candidates during 2020-2021 match cycle reported that 58% had accepted more interviews than they would have if interviews were not virtual. 4 Additionally, 69% of applicants attended a virtual open house, with 57% of whom reported that attending the open house influenced their decision to apply to a program and 63% reporting that it influenced a program’s ranking. We therefore believe that program use of virtual communications/outreach should not be looked at as a detriment but rather as an opportunity to maximize applicant contact, as well as provide flexibility with interviewing.
To conclude, it is evident that the increased congestion within the Match has significant implications into how programs and applicants write their ROLs, which may be more detrimental to certain student populations. We give thanks again to Newsome and colleagues for their investigation and hope that program directors and other stakeholders investigate potential solutions for these contemporary trends.