Assessing the Impact of the COVID-19 Pandemic on Geographic Residency Placement Relative to Medical School Location

Langhan ML. Virtual Interviews and the Pediatric Emergency Medicine Match Geography: A National Survey

Introduction

Virtual interviews (VI) are now a permanent part of pediatric emergency medicine (PEM) recruitment, especially given the cost and equity advantages. Yet inability to visit programs in person can impact decision-making, leading applicants to apply to more programs. Moreover, the cost advantages of VI may encourage applicants to apply to programs farther away than they might otherwise have been willing or able to travel. This could create unnecessary strain on programs. We conducted this study to determine whether PEM fellowship applicants would apply to a larger number of programs and in different geographic patterns with VI (2020 and 2021) as compared to in-person interviews (2018 and 2019).

Methods

We conducted an anonymous national survey of all PEM fellows comparing two cohorts: current fellows who interviewed inperson (applied in 2018/2019) and fellows who underwent VIs in 2020/2021 (current fellows and those recently matched in 2021). The study took place in March-April 2022. Questions focused on geographic considerations during interviews and the match. We used descriptive statistics, chi-square and t-tests for analysis.

Results

Overall response rate was 42% (231/550); 32% (n = 74) interviewed in person and 68% (n = 157) virtually. Fellows applied to a median of 4/6 geographic regions (interquartile range 2, 5). Most applied for fellowship both in the same region as residency (216, 93%) and outside (192, 83%). Only the Pacific region saw a statistically significant increase in applicants during VI (59.9% vs 43.2%, P = 0.02). There was no statistical difference in the number of programs applied to during in-person vs VI (mean difference (95% confidence interval 0.72, -2.8 - 4.2). A majority matched in their preferred state both during VI (60.4%) and in-person interviews (65.7%). The difference was not statistically significant (P = 0.45).

Conclusion

While more PEM fellowship applicants applied outside the geographic area where their residency was and to the Pacific region, there was no overall increase in the number of programs or geographic areas PEM applicants applied to during VI as compared to in-person interview seasons. As this was the first two years of VI, ongoing data collection will further identify trends and the impactof VI.

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.

Relationship Between Residency Match Distance From Medical School and Virtual Application, School Characteristics, and Specialty Competitiveness

INTRODUCTION

The COVID-19 pandemic has disrupted the residency match process by eliminating away rotations and changing from in-person to virtual interviews. In this study, we explore the impact of the COVID-19 pandemic on the geographic match distance of United States (US) senior medical students across all specialties.

METHODS

We collected publicly available student match data between 2018 and 2021 from US allopathic medical schools and calculated match distance between medical school and residency training using a novel metric - the "match space." Match space was codified by whether the student matched at their home institution, home state, adjacent state, same or adjacent US census division (non-adjacent state) or skipped at least one US census division. Adjusting for covariates, ordinal logistic regression correlated school and specialty characteristics with match distance pre- and post-pandemic for all specialties. We defined and ranked specialty competitiveness using predictive values from factor analysis.

RESULTS

A total of 34,672 students representing 66 medical schools from 28 states matched into 26 specialties in 50 states and Canada. Fifty-nine percent of students were from public institutions, and 27% of schools ranked in the top 40 for research. The mean percentage of in-state students by school was 60.3% (range 3-100%). Match space was lower after the pandemic (adjusted odds ratio (OR) 0.94, 95% CI 0.90-0.98; p=0.006), from schools with higher in-state percentages (OR 0.74, 95% CI 0.72-0.76), from top National Institutes of Health-funded institutions (OR 0.88, 95% CI 0.85-0.92), from the Northeast (OR 0.71, 95% CI 0.67-0.75; Midwest reference), and the West (OR 0.67, 95% 0.60-0.74). Match space was higher for students graduating from private schools (OR 1.11, 95% CI 1.05-1.19), from the South (OR 1.62, 95% CI 1.2-1.33), and matching into more competitive specialties (OR 1.08, 95% CI 1.02-1.14). The top five most competitive specialties were Plastic Surgery, Neurosurgery, Dermatology, Orthopedic Surgery, and Otolaryngology. Internal Medicine ranked eighth.

CONCLUSIONS

After the COVID-19 pandemic, students graduating from US allopathic schools matched closer to their home institution. Students attending public schools, schools with more in-state matriculants, and schools with higher research rankings also matched closer to their home institutions. Specialty competitiveness and US census region also impacted match distance. Our study adds insight into how geographic match patterns were influenced by school, specialty choice, and the pandemic.

The Association Between Virtual Interviewing and Geographical Distribution of Matched Residency Programs for General Surgery Applicants

OBJECTIVE

Due to the COVID-19 pandemic, the Coalition for Physician Accountability's work group on Medical Students in the class of 2021 made the recommendation in May of 2020 that the upcoming residency recruitment cycle be conducted virtually. This flexibility may have allowed applicants to apply and interview at programs with less regard to geography, knowing that travel costs of interviewing would not be a factor. Alternatively, applicants who interviewed virtually could choose to remain in a close proximity to their home institutions where they likely have a greater comfort level and familiarity with the community both personally and professionally. We examine the distribution of applicants matched at general surgery residency programs in 2021 to those in 2020 to see if there was a change in geographic variability.

DESIGN

Retrospective review of general surgery residents SETTING: United States general surgery residency programs PARTICIPANTS: 2153 PGY1 categorical general surgery residents who were interviewed virtually and PGY2 categorical general surgery residents who interviewed in-person, who also attended residency programs and medical schools located in the continental United States with publicly accessible residency websites containing necessary biographical information.

RESULTS

A total of 2153 residents were included; 1124 in their PGY1 and 1029 in their PGY2. Average distance from attended medical school to matched program (634.2 vs 662.5), percentage of matched programs within 500 miles of attended medical school (57.3 vs 55.7), average price of flight, when available, from attended medical school to matched program (222.8 vs 230.4), and percentage of attended medical schools with non-stop flight to matched program (42.9 vs 42.9) did not significantly differ between PGY1 and PGY2 residents.

CONCLUSIONS

The decision to adopt virtual interviewing practices compared to previous in-person interviews did not significantly alter the geographical distribution of students' matched programs. The distance from medical school to the matched program, flight availability, and flight pricing remained comparable between residents interviewed in-person and residents interviewed virtually.

Impact of Virtual Interviewing on Geographic Placement for Cardiology Fellowship Recruitment

Background Virtual interviewing for cardiology fellowship was instituted in the 2021 fellowship application cycle because of the COVID-19 pandemic and restricted travel. The impact on geographic patterns of fellow-training program matching is unknown. This study sought to determine if there was a difference in geographic placement of matched fellows for cardiology fellowship match after initiation of virtual interviews compared with in-person interviewing. Methods and Results All US-based accredited cardiovascular disease fellowship programs that participated in the 2019 to 2021 fellowship match cycles and had publicly available data with fellowship and residency training locations and training year were included. Each fellow was categorized based on whether their fellowship and residency programs were in the same institution, same state, same US census region, or different census region. Categories were mutually exclusive. Of 236 eligible programs, 118 (50%) programs were identified, composed of 1787 matched fellows. Compared with the previrtual cohort (n=1178 matched fellows), there was no difference in the geographic placement during the 2021 virtual cycle (n=609 matched fellows) (P=0.19), including the proportion matched at the same program (30.6% versus 31.5%), same state but different program (13% versus 13.8%), same region but different state (24.2% versus 19.7%), or different region (35% versus 33.1%). There was also no difference when stratified by program size or geographic region. Conclusions The use of virtual interviewing in the 2021 cardiology fellowship application cycle showed no significant difference in the geographic placement of matched fellows compared with in-person interviewing. Further study is needed to evaluate the impact of virtual interviewing and optimize its use in fellowship recruitment.