The Residency Selection Process in the New World; Time for a Rethink

Grit and Thoracic Surgery Interest Among Medical Students

OBJECTIVE

This study evaluated the relationship between medical student Grit and thoracic surgery career interest.

DESIGN

An online questionnaire was designed to measure self-reported ratings of Grit among medical student using the Short-Grit scale, as well as thoracic surgery career interest.

SETTING

Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.

PARTICIPANTS

From 2019 to 2021, 192/367 (52.3%) participants in their first or second year of medical school. The cohort was comprised of 109 (56.8%) females while 115 (59.9%) were <24 years of age.

RESULTS

Mean Grit was high (M = 4.159 +/- 0.450) among medical students. There were 80 (41.2%) students interested in thoracic surgery. There was a significant difference in Grit between students with a career interest in thoracic surgery (4.256 +/- 0.442) and those uninterested in thoracic surgery (4.089 +/- 0.444); t(190) = 2.572, p = 0.011; Cohen's D = 0.442. Career interest in thoracic surgery was not influenced by career factor interest.

CONCLUSIONS

Grittier students have a career interest in thoracic surgery. Recruitment teams in thoracic surgery residency programs with high rates of burnout and poor psychological wellbeing among trainees may take interest in these findings.

Considerations for a Holistic Model in Evaluating Medical Students for Cardiothoracic Surgical Residency

Program directors are tasked with selecting whom they think will be the best fit for residency and the next leaders of the field. While numerical metrics have played a vital role in this process, recent changes to student evaluation are reducing the availability of these metrics. This poses unique challenges for both applicants and program directors. Here we discuss how this will likely shift the focus on other parts of the application and the consequences (good and bad) of doing so.

Current Views on the New United States Medical Licensing Examination Step 1 Pass/Fail Format: A Review of the Literature

INTRODUCTION

Residency programs have historically used numerical Step 1 scores to screen applicants, making it a career-defining, high-stakes examination. Step 1 scores will be reported as pass/fail starting in January 2022, fundamentally reshaping the residency application review process. This review aimed to identify opinions of physicians and medical students about the new format, identify arguments in support of or against the change, and determine the implications of this change on the residency selection process.

METHODS

A comprehensive PubMed review was performed in May 2021 to identify articles that discussed the new Step 1 format. Non-English and duplicate articles were excluded. Data collected from each article included publication year, specialty, subjects, and key findings.

RESULTS

A total of 81 articles were included, 26 of which discussed the impact of the new format within surgical fields (32.1%). Remaining articles discussed the implications within the medical community as a whole (n = 33, 40.7%) and nonsurgical fields (n = 22, 27.2%). Studies suggest Program Directors will rely on Step 2 Clinical Knowledge (CK) scores, medical school reputation, applicant familiarity, Dean's letters, recommendation letters, and research in lieu of numerical Step 1 scores. In addition, concerns have been raised that the new format will disadvantage international, osteopathic, and minority applicants while increasing stress surrounding Step 2 CK.

CONCLUSIONS

Within the medical community, there are concerns that Step 2 CK will be used to substitute Step 1 and that resident diversity will diminish due to the new Step 1 format. Holistic candidate consideration will be increasingly important.