R. A. Collins1, S. A. Sheriff2, T. K. Arora3, A. N. Kothari2, C. Cunningham1, C. N. Clarke2 2Medical College Of Wisconsin, Surgical Oncology, Milwaukee, WI, USA 3Augusta University at the Medical College Of Georgia, Surgical Oncology, Augusta, GA, USA 1Massachusetts General Hospital, Surgical Oncology, Boston, MA, USA
Introduction:
General surgery residency is a highly competitive specialty each year. With USMLE Step 1 changing from raw score to Pass/Fail, programs will need to use novel metrics to evaluate applicants’ suitability for interviews and ranking. We aimed to evaluate factors associated with matching into general surgery residency and assess what paths applicants pursue after going unmatched in an application cycle.
Methods:
Data were obtained between 2011 and 2022 from the National Residency Matching Program (NRMP) Applicant and Program Director Surveys and the NRMP Charting Outcomes in the Match reports for general surgery residency. Data included application characteristics of matched and unmatched students, factors cited by program directors in the interview and ranking process, and paths pursued if they went unmatched. Applicants from MD and DO medical schools, including US and international medical graduates, were included in the analysis. Data were analyzed using Wilcoxon rank sum, Chi-square, and univariate logistic regression.
Results:
During the study period, 11,972 applicants applied to an average of 63 ± 21 programs with 67% matching into categorical general surgery residency (CGSR) positions. Matched applicants received more interview offers (12.3 vs. 5.9, p=0.011), attended more interviews (9.8 vs. 5.2, p=0.011), and ranked more programs (9.7 vs. 6.0, p=0.029). There was no difference in match status when evaluating research experience, abstracts/presentations/publications, work experience, volunteer experience, PhD degree, or graduate degree. Matched applicants were more likely to be AOA (17.1% vs. 1.6%, p=0.002) or to attend top 40 NIH funded schools (31.0% vs. 19.4%, p=0.002). Matched applicants had significantly higher scores for Step 1 and Step 2 (236 vs. 224 and 245 vs. 233 respectively, p<0.001). On univariate analysis, the number of ranked programs (OR 1.91, 95%CI 1.35-3.21), mean Step 1 score (OR 1.37, 95%CI 1.17-1,72), and mean Step 2 score (OR 1.53, 95%CI 1.17-1.72) were predictors of matching into CGSR. Program directors cited Step 1, letters of recommendation (LOR), and Step 2 as the top measures evaluated for offering an interview. Interactions with faculty, interpersonal skills, and interactions with house staff were the most cited factors for ranking an interviewee. If an applicant did not match, they were most likely to participate in SOAP for a CGSR or preliminary position and re-apply the next cycle, or pursue research and re-apply the next cycle.
Conclusion:
As residency programs transition to evaluating applications in the Pass/Fail Step 1 era, other factors including Step 2 score and LOR may be more heavily weighted. Interactions with faculty, staff, and residents were important for ranking interviewees; however, these are subject to inherent bias which is cause for concern as we work to achieve a diverse surgical workforce. Structural barriers that may affect match status warrant further evaluation.