Viewpoint From 2 Graduate Medical Education Deans Application Overload in the Residency Match Process

摘要

What is the application cycle experience for current program directors? During recruitment, program directors (PDs) embody roles that run the gamut from marketing director, webmaster, adviser, and advocate to used-car salesman, interrogator, proud parent, and spin doctor. The residency application process begins immediately after the previous year's Match cycle (figure). Initially, PDs examine the previous Match for (1) matched programs of ranked applicants; (2) characteristics of matched and unmatched ranked applicants; (3) applicant characteristics and timing of interview cancellations; (4) lowest-ranked Match compared with previous years; (5) recruitment communication, marketing, faculty and resident involvement, and interviews; and (6) overall costs. Next, applicants from a PD's home institution schedule appointments with the PD to confirm information provided by student affairs deans, clerkship directors,1 and various websites regarding the application process. View larger version (27K) figureRecruitment Cycle for a Program Director;Do programs benefit from a high applicant to position ratio? When applications outnumber positions by 120 to 1, as typically occurs for competitive programs, it may appear that programs have the advantage in the balance between supply and demand. However, by dividing the process into 2 phases, the application and the interview, the balance shifts. In the earlier anesthesiology example, a subset of roughly 150 top-tier candidates apply and are granted the vast majority of interviews to the same set of regional, peer schools with similar demographics. Consequently, demand outstrips supply once programs reach the interview phase, as roughly 350 positions are available at peer-grouped programs. Applicants offered interviews may keep their interview slots until the last minute, which prevents other candidates from being interviewed. This puts 200 positions at risk for not matching. Moreover, applicants who are not top tier are unnecessarily shunted to less competitive programs or a non-match. Because of interview hoarding by top applicants, some PDs report forgoing interview offers to top applicants who historically have matched elsewhere and instead favor lower-tier candidates.2 Another unintended consequence of overapplying is the urgency for PDs to offer early interviews. The PDs know that applicants apply to far more programs than they will ultimately visit for an interview. To pitch their program and avoid cancellations, PDs make early interview offers, prior to the release of the Medical Student Performance Evaluation (MSPE), with interview dates as early as October. Early interview offers prevent holistic review, however, because decisions are made based on incomplete applications.;Why are medical students applying to an increasing number of residency programs? Application creep occurs primarily because “we” tell students to apply to more programs. We, the student affairs deans, look at the prior year application numbers and figuratively push down on the accelerator. We, the accreditation and clinical association bodies, forge an aggressive campaign for Medicare dollars based on the premise of a looming graduate medical education position shortfall. We, the organizations that sponsor the Match and application process, fail to implement effective process improvements to curb the overapplying frenzy despite early warnings that the process is out of control. Other reasons include the ease of applying, lack of fourth-year curriculum requirements, low-intensity program interviews, and basic game theory economics. The ease of the application process leads to overapplying when adding programs to an application list requires only a few clicks on the common application.3 Further, the personal statement does not push students to engage in thoughtful responses to questions. Medical schools and residency programs deserve some blame as well. At 1 school in 2014–2015, only 40% of the students took a clini