Otolaryngology Residency Selection Medical Student Scott P.
Stringer, MD;
effort to improve the otolaryngology matching prothe University of Florida, Gainesville, we sought to obtain the medical student's perspective of the current system. All students who interviewed here over a 3-year period were surveyed regarding the application, interview, and ranking process. In addition, suggestions for improving the system were sought from the students. The application and interviewing patterns of the students surveyed were found to be similar to those of the entire otolaryngology residency applicant pool. We were unable to identify any factors that influence a student's rank list that could be prospectively used to help select applicants for interview. A variety of suggestions for improvements in the match were received, several of which could easily be instituted. A uniform interview invitation date as requested by the students could be rapidly implemented and would provide benefits for both the students and the residency programs. (Arch Otolaryngol Head Neck Surg. 1992;118:365-366) cess
at
for otolaryngology residency Applying time-consuming, and anxiety-provoking for medical students. an
is
a
costly,
venture to secure
Applicants, in an attempt residency in otolaryngology, submit a large volume of nondirected applications in a "shotgun" fashion hoping a
program that will both interview and accept them. The otolaryngology residency director is then over¬ whelmed by a large number of applications for a small number of interview slots and an even smaller number of residency positions. This selection process, however, must be based on increasingly limited information in part due to the lack of uniformity in medical school grading systems and the imminent loss of national board scores. If the goal of the residency director is to obtain the best residents possible, then some accommodation of the de¬ sires and needs of the applicants is prudent. We sought to obtain the medical student perspective of the matching process and to elucidate the factors that influence their rank order list. to find the
Accepted
Perspective
Nicholas J. Cassisi, MD, DDS; William H.
\s=b\ In an
for publication November 7, 1991. From the Department of Otolaryngology, University of Florida College of Medicine, Gainesville. Reprint requests to the University of Florida Health Science Center, PO Box 100264, Gainesville, FL 32610-0264 (Dr Stringer).
Process
Slattery,
MD
SUBJECTS AND METHODS The residency selection process of the Department laryngology at the University of Florida, Gainesville,
of Oto¬ was re¬
viewed for the match years 1989, 1990, and 1991. An average of 250 applications per year for residency were received during this period. Over the 3-year interval, a total of 84 interviews were conducted for either two (1989, 1991) or three positions (1990). Surveys were sent to all students immediately following their interview. The survey sought the following information: num¬ ber of applications submitted, number of invitations for inter¬ view, number of interviews accepted, number of programs ranked, rank of program at which student matched, and total cost of the interview process. In addition, the students were asked to assign a value of importance to a variety of factors that may be important in determining their final rank order list (val¬ ues assigned were from 1, very influential, to 5, not at all influ¬ ential). Finally, the students were invited to comment on the otolaryngology match process.
RESULTS
Of the 84 surveys mailed, 44 were completed and returned. The average student submitted 26 applications (range, seven to 48), received 16 invitations to interview (range, two to 39), and accepted 11 interviews (range, two to 18). The mean number of programs ranked was 10 (range, two to 17). Of the 41 students who accepted a po¬ sition (93 match rate), the average rank of the program accepted was three (range, one to 10). The average esti¬ mated cost of the interview process per student was $2403.41 (range, $500 to $6500). The students indicated that resident satisfaction, the quality of the faculty, and feeling at ease in the program were the most important (average assigned value of 1) factors in their development of a rank order list. Surgery case load, facilities, reputation of the program, location of the program, spouse prefer¬ ence, and the quality of the residents were also considered to be important but to a lesser degree than the above con¬ siderations (average assigned value of 2). Research op¬ portunities, advice of the student's otolaryngology fac¬ ulty, proximity to the student's family, and the interview itself were not as strongly considered (average assigned value of 3 or higher) in making a final ranking. Other fac¬ tors that were identified by the students as significant were: future practice location, quality and difficulty of the general surgery years, length of the program, faculty sta¬ bility, climate, negative rumors from other applicants, organization of didactic teaching, and positive feedback
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from the program. The students provided
suggestions
for
improving the
otolaryngology matching process. The comments and the number of students making these comments are as follow: (1) Coordinate interview dates on a regional basis and be more flexible in arranging interviews (10). (2) Extend invitations for interviews on a uniform date
(eight).
(3) Provide a standard application and a uniform dead¬ line for applications to be received (seven). (4) Limit the number of invitations for interviews (four). (5) Provide housing for students interviewing (three). (6) Provide more exposure to the residents and faculty
(three). (7) Provide more information about the program prior to the interview (three). (8) Have the students limit their number of applications and interviews (three). COMMENT An inordinate increase in the number of applications sub¬ mitted by each student without a concomitant increase in residency positions or interviews granted has created an il¬ lusion of competitiveness. While in fact, the percentage of
successful matches has actually increased over the last sev¬ eral years. Comparable with this study, the average number of applications submitted per student as reported by the 1991 otolaryngology matching program was 25. This number has steadily risen from an average of 12 in the 1983 match. How¬ ever, the number of interviews (seven) granted has not been affected by this change over the same time period. This figure is lower than the average number of 11 interviews identified in this survey, which is most likely due to the fact that some students who register for the match receive few if any inter¬ views. Students tended to rank almost all of the programs at which they interviewed. Of the students who replied, 93% matched at a mean of their third highest ranked pro¬ gram. This is representative of the entire group inter¬ viewed at the University of Florida that matched at a rate of 88%. This is substantially higher than the overall match success rate of 64% for United States seniors reflecting the prescreening effect of being selected for an interview. As expected, it appears that the student's development of a rank order list is based on a variety of factors. The students were most influenced by the perceived quality of the faculty and feeling that they would fit in with the program. It does not appear that such factors could be used prospectively in selecting students for interview, since the information rated as most significant is not available to the student until the time of the interview. Factors such as location of the program, faculty advice, and spouse or family preference are more likely to be in¬ fluential in determining where to apply and accept inter¬ views as opposed to being used in ranking programs. The most common suggestions for improving the oto¬ laryngology matching process focus on the steps leading up to the interview. A uniform application form would result in significant time savings for the students. How¬ ever, this might encourage an increase in applications unless some limit or fee is instituted simultaneously. The Society of University Otolaryngologists and the Associa¬ tion of Academic Departments of Otolaryngology have to date tried unsuccessfully to formulate an application ac¬ ceptable to all programs. Nevertheless, a uniform dead-
line for receipt of all application materials could be imple¬ mented with minimal effort. This would at least make the application process more simple for the students. The acceptance of interviews for "insurance" purposes alone has significant ramifications for other applying medical students and the otolaryngology programs. Since there is a relatively fixed number of interview slots, any interview ac¬ cepted in excess of some reasonable number takes a slot from a potentially qualified student. Residency directors may waste interview slots on students who have no substantial interest in the program. The extension of invitations for in¬ terview on a uniform date would allow the students to se¬ lectively choose those programs in which they had the most interest, thereby eliminating the need to accept interviews while waiting for their top choices. Applicants could also plan their interview trips in the most inexpensive and com¬ prehensive fashion. Regional coordination of interview dates would allow an applicant to make a single trip to one city or region to interview on successive dates at several programs. Some programs grouped in large metropolitan centers or in a region already offer coordinated interviews. However, this would be difficult to accomplish on a national basis, since many programs are not grouped in such a manner as to facilitate such an arrangement due to geography or airline hub design. Additionally, not all students will be invited or desire to go to all the programs in a regional block. Finally, each program must consider the availabil¬ ity of their faculty in setting interview dates. The typical medical student is burdened by an increasing debt after medical school. The average travel expense in¬ curred by the students surveyed was $2403.41, with some reporting costs as high as $6500. This is a significant burden when considered in the context of a large educational loan debt. Any effort to defray these costs is of substantial benefit to the students. For example, we offer housing to the inter¬ viewing applicants with our residents. In addition to de¬ creasing student travel costs, this allows us to get to know the applicants better and to provide further resident exposure for the students. While this arrangement would not be practical for all programs, it is relatively simple for many. The suggestions identified in this survey are similar to those reported by the Society of University Otolaryngologist's Undergraduate Education Committee. Under the chairmanship of Stephen G. Harner, MD, a survey of all students participating in the January 1990 match was conducted. Difficulties in arranging interviews and travel costs were among the most common criticisms received. The committee suggested pursuing the concepts of re¬ gional interviews, a uniform application form, and a uni¬ form date to offer interviews. The goal of the matching process is to allow the programs to match the best possible candidates and to assist the student in obtaining a residency position of their highest possible choice. Currently, this process is being distorted by an inordinate number of applications per student. Any change that can provide a sharper focus for both the programs and applicants should be considered. The issue of a uniform application deserves further atten¬ tion. Regional interviews should continue to be offered wherever possible. A uniform deadline for receipt of ap¬ plication materials and a uniform date for extension of in¬ terview invitations could be instituted within 1 year and resolve many of the problems facing the students and the residency programs.
Downloaded From: http://archotol.jamanetwork.com/ by a Oakland University User on 06/12/2015
Stringer, MD;
effort to improve the otolaryngology matching prothe University of Florida, Gainesville, we sought to obtain the medical student's perspective of the current system. All students who interviewed here over a 3-year period were surveyed regarding the application, interview, and ranking process. In addition, suggestions for improving the system were sought from the students. The application and interviewing patterns of the students surveyed were found to be similar to those of the entire otolaryngology residency applicant pool. We were unable to identify any factors that influence a student's rank list that could be prospectively used to help select applicants for interview. A variety of suggestions for improvements in the match were received, several of which could easily be instituted. A uniform interview invitation date as requested by the students could be rapidly implemented and would provide benefits for both the students and the residency programs. (Arch Otolaryngol Head Neck Surg. 1992;118:365-366) cess
at
for otolaryngology residency Applying time-consuming, and anxiety-provoking for medical students. an
is
a
costly,
venture to secure
Applicants, in an attempt residency in otolaryngology, submit a large volume of nondirected applications in a "shotgun" fashion hoping a
program that will both interview and accept them. The otolaryngology residency director is then over¬ whelmed by a large number of applications for a small number of interview slots and an even smaller number of residency positions. This selection process, however, must be based on increasingly limited information in part due to the lack of uniformity in medical school grading systems and the imminent loss of national board scores. If the goal of the residency director is to obtain the best residents possible, then some accommodation of the de¬ sires and needs of the applicants is prudent. We sought to obtain the medical student perspective of the matching process and to elucidate the factors that influence their rank order list. to find the
Accepted
Perspective
Nicholas J. Cassisi, MD, DDS; William H.
\s=b\ In an
for publication November 7, 1991. From the Department of Otolaryngology, University of Florida College of Medicine, Gainesville. Reprint requests to the University of Florida Health Science Center, PO Box 100264, Gainesville, FL 32610-0264 (Dr Stringer).
Process
Slattery,
MD
SUBJECTS AND METHODS The residency selection process of the Department laryngology at the University of Florida, Gainesville,
of Oto¬ was re¬
viewed for the match years 1989, 1990, and 1991. An average of 250 applications per year for residency were received during this period. Over the 3-year interval, a total of 84 interviews were conducted for either two (1989, 1991) or three positions (1990). Surveys were sent to all students immediately following their interview. The survey sought the following information: num¬ ber of applications submitted, number of invitations for inter¬ view, number of interviews accepted, number of programs ranked, rank of program at which student matched, and total cost of the interview process. In addition, the students were asked to assign a value of importance to a variety of factors that may be important in determining their final rank order list (val¬ ues assigned were from 1, very influential, to 5, not at all influ¬ ential). Finally, the students were invited to comment on the otolaryngology match process.
RESULTS
Of the 84 surveys mailed, 44 were completed and returned. The average student submitted 26 applications (range, seven to 48), received 16 invitations to interview (range, two to 39), and accepted 11 interviews (range, two to 18). The mean number of programs ranked was 10 (range, two to 17). Of the 41 students who accepted a po¬ sition (93 match rate), the average rank of the program accepted was three (range, one to 10). The average esti¬ mated cost of the interview process per student was $2403.41 (range, $500 to $6500). The students indicated that resident satisfaction, the quality of the faculty, and feeling at ease in the program were the most important (average assigned value of 1) factors in their development of a rank order list. Surgery case load, facilities, reputation of the program, location of the program, spouse prefer¬ ence, and the quality of the residents were also considered to be important but to a lesser degree than the above con¬ siderations (average assigned value of 2). Research op¬ portunities, advice of the student's otolaryngology fac¬ ulty, proximity to the student's family, and the interview itself were not as strongly considered (average assigned value of 3 or higher) in making a final ranking. Other fac¬ tors that were identified by the students as significant were: future practice location, quality and difficulty of the general surgery years, length of the program, faculty sta¬ bility, climate, negative rumors from other applicants, organization of didactic teaching, and positive feedback
Downloaded From: http://archotol.jamanetwork.com/ by a Oakland University User on 06/12/2015
from the program. The students provided
suggestions
for
improving the
otolaryngology matching process. The comments and the number of students making these comments are as follow: (1) Coordinate interview dates on a regional basis and be more flexible in arranging interviews (10). (2) Extend invitations for interviews on a uniform date
(eight).
(3) Provide a standard application and a uniform dead¬ line for applications to be received (seven). (4) Limit the number of invitations for interviews (four). (5) Provide housing for students interviewing (three). (6) Provide more exposure to the residents and faculty
(three). (7) Provide more information about the program prior to the interview (three). (8) Have the students limit their number of applications and interviews (three). COMMENT An inordinate increase in the number of applications sub¬ mitted by each student without a concomitant increase in residency positions or interviews granted has created an il¬ lusion of competitiveness. While in fact, the percentage of
successful matches has actually increased over the last sev¬ eral years. Comparable with this study, the average number of applications submitted per student as reported by the 1991 otolaryngology matching program was 25. This number has steadily risen from an average of 12 in the 1983 match. How¬ ever, the number of interviews (seven) granted has not been affected by this change over the same time period. This figure is lower than the average number of 11 interviews identified in this survey, which is most likely due to the fact that some students who register for the match receive few if any inter¬ views. Students tended to rank almost all of the programs at which they interviewed. Of the students who replied, 93% matched at a mean of their third highest ranked pro¬ gram. This is representative of the entire group inter¬ viewed at the University of Florida that matched at a rate of 88%. This is substantially higher than the overall match success rate of 64% for United States seniors reflecting the prescreening effect of being selected for an interview. As expected, it appears that the student's development of a rank order list is based on a variety of factors. The students were most influenced by the perceived quality of the faculty and feeling that they would fit in with the program. It does not appear that such factors could be used prospectively in selecting students for interview, since the information rated as most significant is not available to the student until the time of the interview. Factors such as location of the program, faculty advice, and spouse or family preference are more likely to be in¬ fluential in determining where to apply and accept inter¬ views as opposed to being used in ranking programs. The most common suggestions for improving the oto¬ laryngology matching process focus on the steps leading up to the interview. A uniform application form would result in significant time savings for the students. How¬ ever, this might encourage an increase in applications unless some limit or fee is instituted simultaneously. The Society of University Otolaryngologists and the Associa¬ tion of Academic Departments of Otolaryngology have to date tried unsuccessfully to formulate an application ac¬ ceptable to all programs. Nevertheless, a uniform dead-
line for receipt of all application materials could be imple¬ mented with minimal effort. This would at least make the application process more simple for the students. The acceptance of interviews for "insurance" purposes alone has significant ramifications for other applying medical students and the otolaryngology programs. Since there is a relatively fixed number of interview slots, any interview ac¬ cepted in excess of some reasonable number takes a slot from a potentially qualified student. Residency directors may waste interview slots on students who have no substantial interest in the program. The extension of invitations for in¬ terview on a uniform date would allow the students to se¬ lectively choose those programs in which they had the most interest, thereby eliminating the need to accept interviews while waiting for their top choices. Applicants could also plan their interview trips in the most inexpensive and com¬ prehensive fashion. Regional coordination of interview dates would allow an applicant to make a single trip to one city or region to interview on successive dates at several programs. Some programs grouped in large metropolitan centers or in a region already offer coordinated interviews. However, this would be difficult to accomplish on a national basis, since many programs are not grouped in such a manner as to facilitate such an arrangement due to geography or airline hub design. Additionally, not all students will be invited or desire to go to all the programs in a regional block. Finally, each program must consider the availabil¬ ity of their faculty in setting interview dates. The typical medical student is burdened by an increasing debt after medical school. The average travel expense in¬ curred by the students surveyed was $2403.41, with some reporting costs as high as $6500. This is a significant burden when considered in the context of a large educational loan debt. Any effort to defray these costs is of substantial benefit to the students. For example, we offer housing to the inter¬ viewing applicants with our residents. In addition to de¬ creasing student travel costs, this allows us to get to know the applicants better and to provide further resident exposure for the students. While this arrangement would not be practical for all programs, it is relatively simple for many. The suggestions identified in this survey are similar to those reported by the Society of University Otolaryngologist's Undergraduate Education Committee. Under the chairmanship of Stephen G. Harner, MD, a survey of all students participating in the January 1990 match was conducted. Difficulties in arranging interviews and travel costs were among the most common criticisms received. The committee suggested pursuing the concepts of re¬ gional interviews, a uniform application form, and a uni¬ form date to offer interviews. The goal of the matching process is to allow the programs to match the best possible candidates and to assist the student in obtaining a residency position of their highest possible choice. Currently, this process is being distorted by an inordinate number of applications per student. Any change that can provide a sharper focus for both the programs and applicants should be considered. The issue of a uniform application deserves further atten¬ tion. Regional interviews should continue to be offered wherever possible. A uniform deadline for receipt of ap¬ plication materials and a uniform date for extension of in¬ terview invitations could be instituted within 1 year and resolve many of the problems facing the students and the residency programs.
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