Medical student calls for reform of residency application process


Game day is often revered as a time of celebration for everyone involved. Aspiring physicians learn where they will be heading for their residencies, as they are “matched” with a medical center that offers specialized training in their future areas of expertise.

But Maya Hammoud, MD, MBA, professor of obstetrics and gynecology and health science learning at Michigan Medicine, and Nicole Mott, fourth-year student at the University of Michigan Medical School, note that Match Day isn’t always so cut and dry.

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“While most game day reports typically highlight the 92-95% match rate for senior medical students in the United States, this is only a rough measure for a group very specific of individuals asking to match,” Mott said. “When you dive a little deeper, you will see that some necessary reforms are needed to ensure a fairer process for everything candidates.”

clod author of a perspective in The New England Journal of Medicine with Hammoud, as well as J. Bryan Carmody, MD, MPH, and David A. Marzano, MD He discussed the importance of looking at game day results beyond the overall game rate.

“I am honored to have worked with a medical student on this article, as the perspective of the applicant is very important in trying to resolve the challenges associated with the application and matching processes,” Hammoud said. “It should also remind us every day that unmatched candidates are not a number or a rate. They are each an individual who, after years of hard work and hundreds of thousands of dollars in debt, finds himself out of a job on game day.

Mott adds that their perspective was inspired by “unmatched” medical students who didn’t necessarily understand Why they did not match.

“Many students don’t get enough guidance throughout the residency application process,” she said. “When students aren’t matched, they often feel very lonely and stigmatized. And often, even students who match have unmet expectations, like not matching their first-choice program, for example. These numbers are constantly increasing. »

With that in mind, the team advocates that the National Residence Matching Program, or NRMP, incorporate additional residence match data into their reporting figures.

“The information presented in this document hopefully underscores the importance of looking at matchday results beyond the overall match rate,” Hammoud said. “Overall match rates are not representative of match rates for individual specialties, which are quite variable, with some programs having up to 25% unmatched applicants.”

Mott notes that there are several data gaps in traditional NRMP reporting, including:

  • A lack of information regarding applicants who apply to residency programs (or register for the NRMP match), but do not submit a ranked list. This, in turn, leads to an overestimation of the actual match rate.

  • An absence of data on medical workforce contributions by applicants who do not match or who are placed in a first-year graduate “preliminary position”. These positions traditionally only offer one to two years of training, requiring individuals to reapply for advanced residency positions in the future.

  • Little or no data on detailed matching results (which include specialty-specific matching on rank lists).

“It’s critical that the medical education community — and especially applicants and their advisors — understand the more detailed match results,” Hammoud said. “That way they can make informed decisions about an individual’s future path and career.”

And according to Mott, the “overall congestion” associated with the current residency application process can be alleviated by some concrete changes.

“Our article highlights proposed solutions to existing inefficiencies in the matching process, such as increasing the amount of data sharing between the Association of American Medical Colleges’ electronic residency application service, the Educational Commission for foreign medical graduates and the NRMP, so the data that is available reflects all applicants.

Additionally, Mott notes that tracking applicants who apply for the NRMP match for consecutive application cycles, as well as presenting data on the average ranked list position for matches by specialty, will establish more fairness. in the process.

“I think it’s important to have people who are passionate about solving the problems of this process,” she said. “Since most applicants only go through the matching process once, it’s easy to forget the frustrations associated with it when they move on to the next step. But if you don’t commit to making changes, the next generation will suffer.

Article quoted: “What’s in a number? Breaking down the residential match rate,” The New England Journal of Medicine. DO I: 10.1056/NEJMp2119716.

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