Rising Residency Applications: How High Will It Go?

Otolaryngology-head and neck surgery resident and medical school characteristics: Current paradigm amidst changing application criteria

PURPOSE

To determine the characteristics of current US Otolaryngology-Head and Neck Surgery (Oto-HNS) residents and their medical school.

METHODS

Data were manually collected between Dec 2022 and Jan 2023 for 1649 residents attending 163 US-based ACGME accredited Oto-HNS residency programs, reflecting the 2018-2022 cohort. All data were collected from publicly available sources including residency and medical school program websites, web of science, and professional networking sites (ex: LinkedIn, Doximity). Data were analyzed to determine the "feeder" schools which contributed the greatest number and percent of residents. Using univariable linear regression models, we characterized factors which were associated with feeder school status.

RESULTS

Of 1649 residents analyzed, 364 (22 %) matched to their home program and 918 (56 %) stayed in the region of their medical school. The median [IQR] number of published papers and abstracts was 5 [3, 9] with an h-index of 2 [1,4]. Factors associated with producing a greater percent of Oto-HNS residents include presence of an interest group, presence of a home program, USNWR research rank of the medical school, Doximity reputation rank of the home residency program, average pre-residency h-index of the school's graduates, and total NIH research funding (each p < 0.001).

CONCLUSIONS

In the changing landscape of residency applications after the USMLE Step 1 exam's transition in January 2022 to pass/fail scoring, it is important to objectively characterize current Oto-HNS residents. Findings from this study will inform prospective residents and residency programs seeking to improve access to Oto-HNS. Future small-scale studies may help further identify driving factors within medical school curricula.

Cost Analysis of High-Signal Approach in Otolaryngology-Head and Neck Surgery Residency

OBJECTIVE

The objective of this study is to analyze a high-signal approach for otolaryngology-head and neck surgery (OHNS) residency applicants and calculate cost savings for programs and applicants.

METHODS

Data from both the 2022-2024 Electronic Residency Application Service (ERAS) and a data model were used to demonstrate cost savings with a high-signal approach. Modeled data assumed that the number of applications per applicant would be equal to the number of signals allowed. Predicted and real-world cost savings across the five other specialties participating in a high-signal approach were calculated.

RESULTS

ERAS data cost savings for the entire OHNS applicant pool amounted to $365,950. In the modeled data, cost savings amounted to $825,921. When extrapolated to include all five high-signal specialties, total cost savings amounted to $2,570,464 (ERAS data) and $6,359,478 (modeled data). Otolaryngology programs were predicted to experience significant time savings, resulting in cost savings of $437,883 and $1,113,342 for ERAS data and modeled data, respectively.

CONCLUSIONS

The study highlights the advantages of a high-signal approach, including financial advantages or increased time for programs to engage in holistic review and diversify the pool of interview candidates. Cost savings in this study were shown to be significant when extrapolated across all specialties using a high-signal approach. Further research is needed to optimize the signaling system and confirm the favorable interview distribution and equity data from the low-signal OHNS experience with a high-signal approach.

LEVEL OF EVIDENCE

N/A Laryngoscope, 134:2684-2688, 2024.

Rapidly Increasing Number and Cost of Residency Applications in Surgery

BACKGROUND

Surgical specialties represent the most competitive residency positions to obtain, and applicants for these spots may apply to increasingly more programs in an attempt to match. We describe trends in residency applications across all surgical specialties from 2017 to 2021 application cycles.

MATERIALS AND METHODS

This review of the 2017, 2018, 2019, 2020, and 2021 surgical residency application cycles used the American Association of Medical Colleges' Electronic Residency Application Service (ERAS) databases. Data from a total of 72,171 applicants to United States surgical residencies during the study's time period were included. The 2021 ERAS fee schedule was used to calculate the cost of applications.

RESULTS

The number of applicants across the study interval remains unchanged. Trends suggest more women and underrepresented minorities in medicine are applying to surgical residencies today compared to 5 years ago. The mean number of applications per applicant increased 32.0% from 39.3 in 2017 to 51.8 in 2021, resulting in an increased application fee cost of $329 per applicant. Mean total cost for application fees alone in 2021 were $1211 per applicant. In 2021, the cost of applying to surgical residency for all applicants was over $26 million, a nearly $8 million increase from 2017.

CONCLUSIONS

There has been an increase in the number of applications per applicant in the past 5 residency application cycles. Increased applications create barriers and burdens for applicants, and residency program personnel. These rapid increases are unsustainable and require intervention, although a viable solution has yet to be elucidated.

Key factors for residency interview selection from the National Resident Matching Program: analysis of residency Program Director surveys, 2016-2020

CONTEXT

As the number of medical school graduates continues to outpace the available residency training positions, applying for residency in the United States has become a highly competitive process, often associated with a low rate of selection and invitation for interview. The National Resident Matching Program (NRMP) Program Director survey provides data assessing factors considered by Program Directors (PD) in selecting and inviting candidates for interview. Assessing the evolution of these factors over time is efficacious to inform and guide prospective applicants toward improving preparation for residency application.

OBJECTIVES

We aim to synthesize NRMP data showing factors that PDs reported and rated as important in their decision to select and invite applicants for interview.

METHODS

Data from residency PD surveys from 2008 to 2021 were accessed, but after applying inclusion/exclusion criteria, only the data from 2016 to 2020 were reviewed and analyzed. The NRMP survey reports provided two metrics that characterized PDs' evaluation of the residency factors for interview, namely, "percent citing factor" and "average rating" on a 0 to 5 Likert-type scale. These two metrics were combined into an aggregate measure of importance (AI), and another measure of relative importance (RI) was constructed from normalizing the AI of each individual factor to the sum of the AI within each survey year.

RESULTS

The top ranked factors were United States Medical Licensing Examination (USMLE) Step 1/Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1, Letter of Recommendation (LOR) in the specialty, Medical Student Performance Evaluation (MSPE/Dean's Letter), and USMLE Step 2 Clinical Knowledge (CK)/COMLEX Level 2 Cognitive Exam (CE) score, any failed attempt in USMLE/COMLEX, and perceived commitment to specialty. Factors rising in importance were Audition Elective/Rotation Within Your Department, Personal Statement (PS), Perceived Commitment to Specialty, Perceived Interest in Program, LOR in the Specialty, Other Life Experience, and Personal Prior Knowledge of the Applicant. Factors with declining importance were Interest in Academic Career, Awards or Special Honors in Basic Sciences, Graduate of Highly Regarded US Medical School, Awards or Special Honors in Clinical Clerkships, Lack of Gaps in Medical Education, Awards or Special Honors in Clerkship in Desired Specialty, and Consistency of Grades. Compared to the 2021 PD survey, our findings show continued predictive consistency, particularly related to specialty and program commitment.

CONCLUSIONS

The factors identified for the selection of medical school graduates for interview into a residency program reveal that PDs move toward a more integrated approach. Specifically, PDs are placing increasing emphasis on factors that border on subjective qualities more so than the more traditional, quantitative, and objective metrics. Medical students and educators need to continually apprise themselves of the NRMP data to inform students' preparation endeavors throughout medical school to strengthen their application portfolios and enhance their competitiveness for the matching process.

Medical School Factors Associated With Students Entering Otolaryngology

OBJECTIVE

To determine medical school characteristics that are associated with medical students entering otolaryngology residency programs.

STUDY DESIGN

Cross-sectional study.

SETTING

Publically available data on otolaryngology residents and academic otolaryngology programs.

METHODS

Publicly available websites were used to collect demographic and bibliometric characteristics for 1527 residents in Accreditation Council for Graduate Medical Education (ACGME)-accredited otolaryngology programs accounting for the 2017 to 2021 match periods. For each medical school, information on class size, number of otolaryngology faculty, presence of a home academic otolaryngology program, NIH research funding, presence of a student interest group, and top 10 ranking by Doximity or U.S. News and World Report (USNWR) were collected. Univariate and multivariate analyses were performed between the medical school factors and the percentage of each medical school class that matriculated into an otolaryngology residency program.

RESULTS

On multivariate analysis, the following factors were found to be associated with a higher percentage of graduates entering an otolaryngology residency program: presence of a home academic otolaryngology program (standardized beta value (β) = 0.397, p < 0.0001), a 2021 top 10 ENT ranking according to USNWR (β = 0.206, p = 0.0028), and the average h-index of students from a medical school (β = 0.327, p < 0.0001).

CONCLUSIONS

After controlling for multiple factors including research productivity, we found that the presence of a home academic program and a top 10 ranking on USNWR were associated with an increasing percentage of medical school graduates entering otolaryngology. NIH funding and the number of otolaryngology faculty were not associated with more students matriculating into an otolaryngology residency program. These findings can help guide medical schools and otolaryngology programs to recruit students into the field.

Changes in otolaryngology application requirements and match outcomes: Are we doing any better?

Objectives

Otolaryngology-specific requirements were piloted to minimize applicant and program burdens. We investigated the impact of introducing and then removing these requirements on Match outcomes.

Methods

2014-2021 National Resident Matching Program® data were examined. The primary outcome was the impact of Otolaryngology Resident Talent Assessment (ORTA; prematch 2017, postmatch 2019) and Program-Specific Paragraph (PSP; implemented 2016, optional 2018) on applicant numbers and match rates. Secondary survey analysis assessed candidate perceptions of PSP/ORTA.

Results

Applicant numbers declined significantly during PSP/ORTA (18.9%; p = 0.001). With the optional PSP and postmatch ORTA, applicant numbers increased significantly (39.0%; p = 0.002). Examined individually, mandatory PSP was associated with a significant decline in applicants (p = 0.007), whereas postmatch ORTA was associated with significant increases in applicants (p = 0.010). ORTA and PSP negatively impacted the decision to apply to otolaryngology in 59.8% and 51.3% of applicants, respectively. Conversely, match rate success improved significantly from 74.8% to 91.2% during PSP/ORTA (p = 0.014), followed by a significant decline to 73.1% after PSP was made optional and ORTA moved to postmatch (p = 0.002).

Conclusions

ORTA and PSP correlated with decreased applicant numbers and increased match rate success. As programs seek ways to remove barriers to applying to otolaryngology, the potential consequences of an increasing pool of unmatched candidates must also be considered.

A novel algorithm to reduce bias and improve the quality and diversity of residency interviewees

Objective

Improve the quality and diversity of candidates invited for the Otolaryngology‐Head and Neck Surgery residency match by reducing geographical and inter‐rater bias with a novel geographic distribution algorithm.

Methods

Interview applicants were divided into geographic regions and assigned to reviewers. Each reviewer selected by force‐ranking a pre‐determined number of applicants to invite for interviews based on the percentage of applications received for each region. Our novel geographic distribution algorithm was then applied to maintain the geographic representation and underrepresented minority status of invited applicants to match the applicant pool.

Results

Analysis of previous interview selection methods demonstrated a statistically significant overrepresentation of local applicants invited for interviews. In 2022, 324 domestic applications were received for the otolaryngology match, which were divided into six geographic regions. There was no significant difference in USMLE scores between regions. The implementation of our distribution algorithm during applicant selection eliminated local overrepresentation in the invited pool of applicants and maintained the representation of underrepresented minority applicants. Following the match, reviewers indicated that implementation of the geographic distribution algorithm was simple and improved the quality and diversity of the group of interviewed applicants.

Conclusion

Traditional methods of scoring and inviting otolaryngology residency applicants can be confounded by regional and inter‐rater biases. Employing a geographic distribution algorithm improves the quality and diversity of invited applicants, eliminates bias, and maintains the representation of underrepresented minority applicants.

COVID-19 Increased Residency Applications and How Virtual Interviews Impacted Applicants

Background

The number of residency applications submitted by medical students has risen at an alarming rate, causing increased cost of applications and subsequent interview travel. These both contribute to increased cost for medical students. In light of these concerns, specialty governing bodies have proposed ideas to fight these trends including, application limits, interview limits, using a preference signaling system, and continuing virtual interviews. During the Covid-19 pandemic, all residency interviews were performed virtually, essentially making travel expenses negligible. However, this created a new concern with regards to assessing program and applicant compatibility, as compared to in-person interactions and did nothing to combat the increases in application numbers. Therefore, we want to critically assess the effects of virtual interviews on number of applications submitted, number of interview invites received, and number of interviews attended. We also aim to analyze how applicants viewed the virtual process.

Methods

600 medical students were eligible to participate. 456 students from years 2018-2020 were eligible to be surveyed following the NRMP match. 144 students were eligible to be surveyed following 2021 NRMP match. The survey was distributed to medical school graduates just prior to graduation and asked how many programs each student applied to, how many interview invites they received, and how many interviews they attended. The 2021 survey also asked, “How did virtual interviews affect your interview experience?” The quantitative results were compared with student's t-test and qualitative results are presented below. 

Results

The average number of programs each applicant applied to increased from 35.4 to 47.7 (p-value=0.002) when residency interviews switched from in-person to virtual. However, interview invites received and interviews attended did not change (16.8 vs 16.3, p-value=0.91, 11.8 vs 12.7, p-value=0.18). There were 188 participants in the in-person interview group (response rate=41.2%) and 128 participants in the virtual interview group (response rate=83.3%). The standard deviation and range also increased for number of applications, number of interview invites received, and number of interviews attended. 

There were 123 responses to the free response question. 36 had a positive experience, 44 were neutral, 47 were negative. The positive themes included 15 noted less expenses, 18 noted more convenient/less time, and 18 were able to attend more interviews. Negative themes included, 38 noted difficulty assessing program fit, 19 wanted to see the program or city in person, eight had increased interest in home/local programs, six found it difficult to make connections or stand out. 

Conclusion

Sixty-three percent of students reported a positive or neutral experience with virtual interviews. Students applied to more programs when interviews were virtual, but did not receive more interview invites or attend more interviews. These results suggest that virtual interviews are sufficient to conduct residency interviews, however the number of applications continues to rise with no increase in the number interview invites received or number of interviews attended. The increase in the standard deviation and range for all three variables may point to some applicants being able to get more invites and attend more interviews leaving less available spots for other applicants. 

Machine Learning for The Prediction of Ranked Applicants and Matriculants to an Internal Medicine Residency Program

Phenomenon: Residency programs throughout the country each receive hundreds to thousands of applications every year. Holistic review of this many applications is challenging, and to-date, few tools exist to streamline or assist in the process for selecting candidates to interview and rank. Machine learning could assist programs in predicting which applicants are likely to be ranked, and among ranked applicants, which are likely to matriculate.Approach: In the present study, we used the machine learning algorithm Random Forest (RF) to differentiate between ranked and unranked applicants as well as matriculants and ranked non-matriculants to an internal medicine residency program in northern New England over a three-year period. In total, 5,067 ERAS applications were received during the 2016-17, 2017-18, and 2018-19 application cycles. Of these, 4,256 (84.0%) were unranked applicants, 754 (14.9%) were ranked non-matriculants, and 57 (1.12%) were ranked matriculants.Findings: For differentiating between ranked and unranked applicants, the RF algorithm achieved an area under the receiver operating characteristic (AUROC) curve of 0.925 (95% CI: 0.918-0.932) and area under the precision-recall curve (AUPRC) of 0.652 (0.611-0.685), while for differentiating between matriculants and ranked non-matriculants, the AUROC was 0.597 (95% CI: 0.516-0.680) and AUPRC was 0.114 (0.075-0.167). The ranks of matriculated applicants were significantly higher using the algorithmic rank list as compared with the actual rank list for the 2017-18 (median rank: 98 versus 204, p < .001) and 2018-19 cycles (74 versus 192, p = .006), but not the 2016-17 cycle (97 versus 144, p = .37).Insights: The RF algorithm predicted which applicants among the overall applicant pool were ranked with impressive accuracy and identified matriculants among ranked candidates with modest but better-than-random accuracy. This approach could assist residency programs with triaging applicants based on the likelihood of a candidate being ranked and/or matriculating.

COVID-19 and the Otolaryngology Match: An Increase in Applicants Remaining Close to Home

Introduction: Otolaryngology residency remains one of the most competitive surgical subspecialties to apply for with a 63% match rate in 2021. This is a difficult and stressful process for applicants in any given year, and it was even further complicated by restrictions mandated by coronavirus disease 2019 (COVID-19) protections. Analyzing geographical trends in successfully matched applicants provides prospective applicants and programs with helpful information about how previous trends were affected by the pandemic as we look toward future match cycles.

Methods: The medical schools of 1,587 successfully matched applicants from 2017-2021 were identified and compared to the 116 otolaryngology residency programs. Successful applicants’ medical school state and region were then compared to the location of their matched residency program state and region. From this, we evaluated the number of applicants matching at the residency program affiliated with their medical school or at a residency program within the same state or region as their home medical school.

Results: A significant increase in the percentage of applicants matching at their home program and within their home state (p < 0.001) occurred in 2021 when compared to previous years. Applicants matching within their home region was not found to increase significantly (p = 0.43) in 2021 compared to previously. The regions with the greatest increase in the percentage of applicants matching to their home programs were the Northeast and Midwest (12% increase), while the Midwest had the largest increase in percentage of applicants matching within their home state (15%).

Conclusion: The COVID-19 pandemic significantly affected the otolaryngology match in 2021 with applicants and programs alike choosing to stay closer to home with their residency match selections. Overall, regional location remains a major determinant of future residency location for otolaryngology applicants, and this did not change significantly during 2021, but applicants matched more frequently at their home medical school program. It is anticipated that the match process will be similar in 2022 given the ongoing pandemic, so the importance of home program and region will likely be emphasized again.

Geographic Trends in the Otolaryngology Match (2016-2020)

Objective

Presenting geographic matching trends over 5 match cycles (2016-2020) to serve as a context for changes in residency match outcomes due to the coronavirus disease 2019 (COVID-19) pandemic.

Study Design

Retrospective review.

Setting

Single academic institution-affiliated otolaryngology–head and neck surgery residency program.

Methods

Residency match outcomes for all applicants to our institution (2015-2019) were collected from the National Residency Matching Program, including medical school and matched program. Matches were categorized as home program, home region, or out of region and sorted by US geographic region. Statistical analysis included frequencies, totals, χ² testing, and binary logistic regression.

Results

From 2016 to 2020, the US MD senior match rate was 84.9%: 18.9% to home programs, 35.7% to home region, and 45.3% to out of region. Rates were similar across regions and decreased over time. Westerners matched to home programs more than Southerners or Midwesterners (27.5% vs 16.0% and 16.0%, P < .01). Southerners and Westerners were more likely to match within their regions (South: 63.1%, P = .011, odds ratio [OR] = 1.296, 95% CI, 1.060-1.584; West: 42.0%, P = .018, OR = 1.462, 95% CI, 1.066-2.004). Matching from out of region was more likely in the West and less likely in the South (West: 58.0%, P = .017, OR = 1.379, 95% CI, 1.059-1.796; South: 36.9%, P < .001, OR = 0.584, 95% CI, 0.47-0.727).

Conclusion

From 2016 to 2020 in otolaryngology–head and neck surgery, about 1 in 5 matches were to home institutions, a trend that appeared to be more common in the West. Over 4 out of 5 trainees match to nonhome programs, and nearly half relocate to a new region for training. Changes to travel, rotations, and interviews due to COVID-19 may influence these trends.

The Case for Capping Residency Interviews

OBJECTIVE

To determine 2020 residency cycle application practices and to model potential consequences in the 2021 cycle if (1) applicants scheduled an uncapped number of interviews; (2) applicants were capped to schedule 12 interviews; (3) residency programs kept their number of interview offers unchanged; and (4) programs increased their interview offers by 20%.

DESIGN AND SETTING

The authors sent an anonymous survey to all obstetrics and gynecology applicants registered through the Electronic Residency Application Service in February 2020 asking respondents to share demographics and number of interview offers received and completed. Based on prior estimates that 12 interviews are needed to match in obstetrics and gynecology, respondents were divided into Group 12+ (those receiving ≥12 interview offers) and Group <12 (those receiving <12 offers). Model assumptions were (1) applicants can complete all interviews they are offered because they are virtual; (2) interview offers that applicants in Group 12+ decline are subsequently offered to applicants in Group <12; (3) the proportions of interviews offered to Group 12+ and Group <12 will remain the same if programs chose to increase their total number of interview spots.

PARTICIPANTS

Among 2508 applicants, 750 (30%) provided the number of interview offers received and completed: 417 (56%) in Group 12+ and 333 (44%) in Group <12.

RESULTS

In models where applicants are uncapped in the number of interviews, Group <12 applicants receive <1 interview offer, even if programs increase the number of interviews offered and performed. If applicants are capped at 12 interviews, Group <12 applicants will receive 9 interview offers on average and will reach 12 if programs increase the number of interviews offered by 20%.

CONCLUSIONS

This work highlights how current inefficiencies may lead to negative consequences with virtual interviews. Interview caps and preference signaling systems need to be urgently considered.

Time and Financial Costs for Students Participating in the National Residency Matching Program (the Match©): 2015 to 2020

Introduction

The purpose of this study was to provide information to assist students, faculty, and staff in making critical career-determining decisions regarding the residency NRMP “Match^©” process.

Methods

A 47-item survey questionnaire was developed and piloted on a regional medical school campus in 2015. The revised questionnaire was distributed each year from 2016 to 2020 to fourth-year medical students after rank lists had been submitted. The questionnaire incorporated a request for comments about the interviewing experience and suggestions to improve the process. This narrative feedback was coded using a thematic analysis.

Results

The overall response rate was 86.1% (897/1,042). Annual response rates ranged from 70.0% in 2020 to 97.0% in 2018. Respondents’ average age was 27.3 (± 2.7) years and 50.0% (448/897) were male. Most applied to family medicine (164/897; 18.2%) and internal medicine (140/897; 15.6%). Eight specialties had fewer than ten applicants over the six-year period. The number of students applying to individual specialties fluctuated annually, but no specialty showed a consistent upward or downward trend over the study period.

Conclusions

This study found huge differences in numbers of applications, expenses, and days interviewing. Students crave more guidance, a more efficient system, transparent communication with programs, and less pressure during the process. Reducing escalating volumes of applications is central to improving the system. Despite efforts to inform applicants better, student behavior is unlikely to change until they feel safe in the belief that lower and more realistic numbers of applications and interviews are likely to result in securing an appropriate residency position.

Current Applicant Perceptions of the Ophthalmology Residency Match

Importance

The ophthalmology residency application process is critical for applicants and residency programs, and knowledge about the preferences of applicants would assist both groups in improving the process.

Objective

To evaluate the experiences and preferences of ophthalmology residency applicants.

Design, Setting, and Participants

This cross-sectional, nonvalidated survey was conducted online. All applicants to the Bascom Palmer Eye Institute ophthalmology residency program during the 2018-2019 application cycle were invited to complete the survey. Data collection occurred from April 1, 2019, to April 30, 2019.

Main Outcomes and Measures

Applicant demographics, application submissions, interview experiences, financial considerations, match results, and suggestions for improvement of the application process.

Results

Responses were received from 185 applicants (36.4%), including 77 women (41.6%). A successful match into an ophthalmology residency was achieved by 172 respondents (93.0%). There was a mean (SD) US Medical Licensing Examination Step 1 score of 245.8 (13.3) points. Respondents applied to a mean (SD) of 76.4 (23.5) ophthalmology residency programs, received 14.0 (9.0) invitations to interview, and attended 10.3 (4.4) interviews. Choices regarding applications and interviews were based mostly on program reputation, location, and advisor recommendation. A usual lead time of at least 3 weeks between the invitation and interview was reported by 126 respondents (69.2%), which was reduced to 14 respondents (15.1%) when a wait-list was involved. The ophthalmology residency application process cost a mean (SD) of $5704 ($2831) per applicant. Respondents reported that they were most able to reduce costs through housing choices (hotel stays or similar arrangements) and least able to reduce costs by limiting the number of programs to which they applied or at which they interviewed.

Conclusions and Relevance

The ophthalmology residency application process is complex and poses substantial challenges to applicants and residency programs. These findings suggest that many current applicants have difficulty selecting programs to apply to, and most respondents desired changes to the current system of interview invitations and scheduling.

Otolaryngology Applicant Characteristics and Trends: Comparing OTO-HNS with Peer Specialties

PURPOSE

To evaluate the recent Otolaryngology-Head and Neck Surgery (OTO-HNS) applicant characteristics, to identify which applicant characteristics are associated with successful match into OTO-HNS, and to compare OTO-HNS applicant trends and characteristics to that of peer surgical specialties (PS).

MATERIALS AND METHODS

Data were obtained from official reports by the National Residency Matching Program (NRMP) for OTO-HNS, plastic and reconstructive surgery, orthopedic surgery, neurosurgery, and dermatology from 2006 to 2019. Alpha Omega Alpha (AOA) membership, United States Medical Licensing Examination (USMLE) scores, research productivity, graduation from a top-40 NIH-funded U.S. medical school, and additional graduate degree were recorded. Odds ratios (OR) were calculated to evaluate the relationship between applicant qualifications and match success.

RESULTS

From 2014 to 2018, the OTO-HNS applicant pool shrunk from 443 to 333, representing the largest drop of all PS. Furthermore, OTO-HNS reported the most unfilled positions and highest match rates in 2017 (n = 14; 92.1%) and 2018 (n = 12; 94.6%) among any PS. Despite recent trends, 2019 NRMP data revealed a 38.74% increase in OTO-HNS applicant numbers compared to 2018. AOA membership (OR, 7.3; P = .030), USMLE Step 2 scores between 241 and 260 (OR, 6.5; P = .009), and research productivity (OR, 5.6; P = .005) significantly increased the odds of matching into OTO-HNS.

CONCLUSIONS

Despite recent fluctuations in application trends, OTO-HNS continues to successfully match highly qualified applicants, including applicants with AOA membership, high Step 2 scores, and high research productivity. An understanding of the qualifications used to evaluate residency applicants may be helpful to both applicants and residency programs of OTO-HNS.

COVID-19’s Impact on the 2020-2021 Resident Match: A Survey of Otolaryngology Program Directors

Objective:

To determine the impact coronavirus disease of 2019 (COVID-19) will have on the 2020-2021 otolaryngology (OTO-HNS) resident application cycle.

Methods:

A cross-sectional survey targeting OTO-HNS program directors (PD) was created and disseminated via email to PDs on May 28th 2020. Descriptive analyses of the 19-question survey was performed, and free text responses for certain suitable questions were thematically categorized into groups determined to be relevant during analysis.

Results:

Twenty-nine of 123 solicited PDs (23.6%) completed the survey. Nineteen (65.5%) respondents indicated they would not host away rotations (AR) in 2020, and 9 (31.0%) reported that they would consider away rotators without home programs. Regarding the historical importance of AR, 21 (72.4%) PDs stated they were either “extremely” or “very” important in evaluating candidates. Sixteen (55.2%) PDs stated that virtual interviews would impact their ability to properly gauge candidates and 12 (41.4%) were unsure. Eight PDs (27.6%) stated their evaluation of candidates will likely change, with a shift toward an increased reliance on letters of recommendation, research involvement, and clerkship grades. The large majority of PDs—25 (86.2%)—were not worried that the COVID-19 pandemic would affect the abilities of new interns beginning in 2021.

Conclusion:

Virtual interviews and engagement activities will mostly supplant sub-Is and AR for the 2020-2021 OTO-HNS application cycle. Surveyed PDs largely believe these will be insufficient in providing a comprehensive assessment of candidates, and will similarly limit applicants’ ability to gauge residency programs. Criteria utilized to evaluate students is expected to change.

Ideas and Innovations to Improve the Otolaryngology–Head and Neck Surgery Residency Application and Selection Process

Objective

To (1) summarize strategies proposed in the recent otolaryngology–head and neck surgery (OTO-HNS) literature for improving the residency application and selection process, (2) evaluate the effects of recently implemented changes to the OTO-HNS match, and (3) discuss recommendations for future changes to the OTO-HNS residency application and selection process.

Data Sources

PubMed, Medline Ovid database, and article reference lists.

Review Methods

A structured literature search was performed to identify current English language articles relating to the objectives of this study using the aforementioned data sources, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. The search was limited to submissions published between January 1, 2015, and January 1, 2020.

Conclusions

Numerous proposals have been made for improving the otolaryngology residency application and selection process and addressing the competitive nature of the Match. These proposals include but are not limited to mandating a secondary essay, implementing consortia and early match processes, using a signaling system, conducting regional and web-based interviews, offering early engagement with interest groups, instituting a hard cap on applications, increasing costs of applying, counseling self-restraint to prospective applicants, and creating application filters.

Implications for Practice

As the volume of literature surrounding the OTO-HNS Match continues to increase, this review aims to provide a summary of past proposals and serve as a guide for possible future innovations. We propose 3 initiatives that may improve the residency application and selection process for both program and resident, with minimal impact to the current National Resident Matching Program (NRMP) Match structure.

Otolaryngology Match Trends: Considerations for Proper Data Interpretation

There is an extensive amount of data available from the leading organizations involved in the residency selection process. Tracking trends in otolaryngology residency applications and match outcomes is vital to understand the pipeline of individuals joining our profession. As we make changes to the application or match process, proper interpretation of available data is vital to prevent erroneous analyses and inappropriate conclusions. In the commentary, we explore the nuances of data from the Electronic Residency Application Service and National Residency Matching Program to help our specialty direct research endeavors and policy changes that will ultimately affect the makeup of our future workforce.

Examining the Otolaryngology Match and Relationships Between Publications and Institutional Rankings

This study examines associations among publication number, National Institutes of Health (NIH) funding rank, medical school research rank, and otolaryngology department ranks of otolaryngology applicants during the 2018-2019 match cycle. Information regarding 2018-2019 otolaryngology applicants was collected from Otomatch.com and verified via department websites. Information was also collected regarding 2018 NIH funding rank and 2020 US News & World Report research rank of medical schools and otolaryngology departments. T tests and chi-square analyses were performed. Top 40 NIH funding rank, top 40 medical school research rank, and home institution department rank were separately associated with more publications and higher rates of matching into highly reputed otolaryngology departments (all P < .01). Furthermore, applicants who matched into ranked otolaryngology departments averaged significantly more publications (P < .01). Prospective otolaryngology applicants should take into account NIH funding rank, medical school research rank, and otolaryngology department rank, as they are associated with matching into high-ranking institutions.

Trends in the 10-year history of the vascular integrated residency match: More work, higher cost, same result

OBJECTIVE

The purpose of this study was to examine trends in application submission, rank lists, and applicant quality for vascular surgery integrated residency.

METHODS

The National Resident Matching Program Results and Data reports and the Electronic Residency Application Service Statistics from 2007 to 2017 were compiled and mined for trends in terms of application submission and the number of applicants a program needed to rank to fill all residency positions. Applicant pool depth and percentage of programs applied to were calculated. Outcome data from the National Resident Matching Program were reviewed for 2014 and 2016 for United States Medical Licensing Examination Step scores and experiences.

RESULTS

During the last 10 years, the number of vascular surgery integrated residency spots rose from 9 to 60 per year. Most programs offer one spot per year; none offer more than two. The average number of applications received by programs rose from 17 applications in 2008 to 63.8 in 2017. The average rank list depth needed by programs to fill the spots has not increased (range, 2.5-5.1; standard deviation, 0.73). The proportional depth of the applicant pool decreased from 4.6 U.S. and Canadian applicants for every one residency spot in 2008 to 1.7 applicants for every one residency spot in 2017. Applicant quality metrics were available for 2 years (2014 and 2016). Step 1 scores (237/239), Step 2 scores (250/250), research experiences (3.7/4.2), and volunteer experiences (5.9/5.5) remained nearly unchanged. The number of contiguous ranks for matched applicants remained stable (12.3/12.8).

CONCLUSIONS

The current system promotes multiple inefficiencies, resulting in application glut. Fewer applicants are flooding programs with an increasing number of applications. More money is being spent on Electronic Residency Application Service applications without changes in the number needed to rank by applicants or programs to achieve a match. There is no improvement in the quality of the applicant. Should these trends continue, they represent an unsustainable model for resident selection.

Competitiveness of Otolaryngology Residency Applicants without a Home Program

Purpose:

Investigate if otolaryngology residency home programs (HP) are associated with advantages in National Resident Matching Program match compared to applicants without HPs.

Methods:

Surveys were distributed to fourth-year medical students applying to otolaryngology residency (2015-2016 cycle) via OHNS (2015-2016) Applicants Closed Facebook Page and Otomatch. Applicant data analyzed included HP, United States Medical Licensing Examination (USMLE) scores, number of away rotations, and matching at top choice.

Results:

Applicants were grouped: (1) HP, (2) no HP but have ENT staff (staff), and (3) no HP or staff (none). Ninety-five percent of survey participants matched into otolaryngology (n = 62). A sub-analysis of match preference among matching applicants revealed 63% of participants with HP matched to their first choice compared to 56% (staff) and 14% (none) ( P = .058). Match rate between those with any staff (HP or staff) versus those without was statistically significant ( P = .037). Applicants without HPs went on more away rotations than students with HPs (mean: 2.5 ± 0.5 vs 1.7 ± 0.07, P = .0002). No statistical significance was seen between applicants with/without HP in regards to USMLE scores, publications, or number of interviews.

Conclusion:

Applicants applying to otolaryngology residency without HPs are as competitive as those who have HPs. However, without HPs, applicants tend to participate in more away rotations and are less likely to match at their top choice.

I dream of Gini: Quantifying inequality in otolaryngology residency interviews

OBJECTIVES

Otolaryngology applicants routinely decry conflicting interview dates because this limits the number of interviews that one can attend, despite being offered an interview. Conversely, applicants also perceive that a large number of interviews are offered to a minority of applicants. We sought to verify and quantify the inequality in distribution of interviews attended.

STUDY DESIGN

Retrospective analysis of the National Resident Matching Program (NRMP) 2016 Charting Outcomes in the Match and Electronic Residency Application Service (ERAS) historic specialty data.

METHODS

The Gini coefficient, a commonly used indicator of economic inequality, was calculated using data from the 2016 Charting Outcomes in the Match to estimate the distribution of interviews attended. This data was compared to nine other specialties, comprising a wide range of competitiveness and specialty size.

RESULTS

26% (110 of 416) of otolaryngology applicants accounted for half (1,721 of 3,426) of all possible interview positions. The Gini coefficient ranged from 0.43 to 0.84 across 10 specialties, with a higher coefficient indicating higher inequality. The Gini coefficient among otolaryngology applicants was 0.43, indicating lower inequality than most other specialties. When including only applicants who interviewed, the Gini coefficient was 0.23.

CONCLUSION

There is an unequal distribution of interview invitations, which likely reflects the reality of asymmetry in applicant competitiveness. Otolaryngology demonstrates the greatest equality in distribution, which may stem from a greater burden of hoarding. The specialty's perceived competitiveness mitigates factors such as cost and time, essentially encouraging more people to take as many interviews as they can.

LEVEL OF EVIDENCE

NA Laryngoscope, 129:627-633, 2019.

Match 2017: Blindsided or Fumbled?

The field of otolaryngology has historically enjoyed extreme interest among residency applicants. However, in the past few years, the number of applicants has precipitously dropped, so that there is no longer a significant excess of applications. It remains important for academic programs to promote student interest in otolaryngology, to break down barriers that may dissuade excellent candidates, and to widen the welcome.

Applicant Perspectives on the Otolaryngology Residency Application Process

Importance

It has been nearly 25 years since medical students were queried regarding their perspectives on otolaryngology-head and neck surgery (OHNS) residency selection. Understanding this viewpoint is critical to improving the current application process.

Objective

To evaluate the perceptions of 2016 OHNS residency applicants regarding the application process and offer suggestions for reform.

Design, Setting, and Participants

In this cross-sectional study of anonymous online survey data, a 14-question survey was designed based on resources obtained from a computerized PubMed, Ovid, and GoogleScholar database search of the English language from January 1, 1990, through December 31, 2015, was conducted using the following search terms: (medical student OR applicant) AND (application OR match) AND otolaryngology. The survey was administered to 2016 OHNS residency applicants to examine 4 primary areas: current attitudes toward the match, effect of the new Otolaryngology Program Directors Organization personal statement mandate, sources of advice and information, and suggestions for improvement. In January 2016, an email was sent to 100 program directors asking them to distribute the survey to current OHNS applicants at their institution. One follow-up reminder email was sent in February 2016. A link to the survey was posted on the Otomatch.com homepage on January 28, 2016, with the last response received on March 28, 2016.

Main Outcome and Measures

Survey responses regarding the residency application process.

Results

A total of 150 of 370 residency applicants (40.5%) responded to the survey. Of these, 125 respondents (90.6%) noted applying to programs in which they had no specific interest simply to improve their chances of matching. Applicants intended to apply to more programs than they actually did (63.6 vs 60.8; r = 0.19; 95% CI, -0.03 to 0.40). Program directors advised fewer applications than other sources; however, 58 respondents (38.7%) did not receive advice from a program director. A total of 121 respondents (80.7%) found online program information to be insufficient. Finally, 90 of 140 respondents (64.3%) noted that they would agree to a hard cap on applications, among other suggestions for improvement.

Conclusions and Relevance

Several main themes emerged from the data, providing a foundation for process improvement opportunities: careful consideration to applicant mentorship, including peers; uniform set of criteria for residency program websites; and investigating alternative match platforms, which may allow hard caps, flagging programs of higher interest, or wave application cycles. Overall, the otolaryngology applicant provides a unique perspective regarding the current state of the match and potential opportunities for system-wide improvement.

Current Interview Trail Metrics in the Otolaryngology Match

Objectives To identify how applicants to otolaryngology residency determine how to apply to, interview with, and rank programs on the interview trail and to determine the extent of the financial burden of the otolaryngology interview trail. Study Design Web-based survey distributed in March and April 2016. Setting Otolaryngology residency applicants throughout the United States. Subjects and Methods Applicants to otolaryngology residency during the 2016 match cycle and current otolaryngology residents were surveyed. Results Median number of applications, interview offers, interviews attended, and programs ranked was not different during the 2016 match and the previous 5 match years. The most important factor affecting the number of applications was the need to apply widely to ensure sufficient interview offers. The most common reason for declining an interview offer was scheduling conflict. Applicants during the 2016 match spent a median of $5400 applying and interviewing for otolaryngology residency. Conclusions Median number of applications, interview offers, interviews attended, and programs ranked has not changed. The most cited reason for applying to many programs was to increase the chances of matching, but this is not statistically likely to increase match success. We advocate for continued attempts to make the otolaryngology match process more transparent for both applicants and resident selection committees, but recognize that applicants are likely to continue to overapply for otolaryngology residency positions.

Variability of Ratings in the Otolaryngology Standardized Letter of Recommendation

Objective

To determine the variability of ratings given to students on the otolaryngology standardized letter of recommendation (SLOR).

Study Design

Retrospective review.

Setting

Academic otolaryngology training program.

Subjects and Methods

496 SLORs to the Cleveland Clinic Otolaryngology Training Program were reviewed. The SLORs were extracted from the applications and analyzed. The distributions of ratings across the 10 categories were statistically analyzed including distribution and standard deviation. Rankings were grouped into deciles for this analysis.

Results

Ratings across the 10 domains revealed clustering of results across the top 2 deciles. The distribution of the bell-shaped curve was shifted significantly to the left, representing the upper deciles. No evidence of gender or geographic bias was found. Longer length of time of association between the applicant and the letter writer correlated to a higher ranking.

Conclusion

The explosion of applications being sent out by candidates for otolaryngology residency programs has prompted the implementation of the SLOR. The lack of variation in the ratings across the 10 domains does not allow for differentiation among student applicants. Reliance on the narrative letter of recommendation attached to the SLOR still remains the most significant way to differentiate among applicants. Refinements will need to be made in either the structure or use of the SLOR for it to be a more useful tool.