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Should medical students be able to apply to dozens of residency programs?

Every year on the third Friday of March, fourth-year medical students and their families anxiously await to see where the almost-doctors will go to receive the home stretch of their medical education. Match day is the crescendo to a long process for fourth-year students that often includes applying to dozens of residency programs, a practice that was recently criticized in a new article in Academic Medicine.

The authors of the article said that applying to so many programs disrupts the students’ fourth year of school and costs a lot of money. This “frenzy” has placed an unrealistic expectation on a process that has not always been so large in scope.

"There's been this inexorable intensification of the residency selection process such that it's basically taken over the fourth year of medical school," said Dr. Phil Gruppuso, a professor of pediatrics in the Warren Alpert Medical School of Brown University and a former associate dean for medical education. "It so dominates student time and energy during the fourth year that it's become very difficult to do any curriculum planning."

The statistics presented by Dr. Eli Adashi, co-author of the article and former dean of medicine and biologic sciences at Brown, show that in 2005 students nationally applied to an average of 30.3 programs, but by 2015 that number had risen to 45.7. For highly competitive specialties like orthopedic surgery, the numbers increase even more.

If medicine were a field with a shortage of jobs, these numbers would make sense – students would need to apply for more positions if their likelihood of being employed was not very high. In reality, 50 to 60% of students in the Match program receive their top choice residency program and more than 90% receive a match in their desired field.

The authors did not have national data on the average number of interviews students receive, but a survey at the Alpert Medical School suggests that the number of interviews are comparable to the number of applications. This means students are travelling to interviews for a substantial portion of their fourth-year.

Travelling to multiple interviews places a large financial burden on students, which may disadvantage those from a low socioeconomic background. Additionally, the high volume of applications can be overwhelming to residency program leaders and lead to a less holistic review process that relies more heavily on test scores rather than qualitative indicators of ability.

"Should this occur, it could have a detrimental effect on the ability of GME programs to achieve diversity by reducing the selection of students from disadvantaged educational backgrounds who may be at risk for underperformance on standardized examinations," the authors wrote.

The authors call for more data as to assess the true effects on students of applying to so many programs. It is possible that the large volume of applications is necessary, but equally so that students may have long passed the point of diminishing returns.

The authors propose a few steps that medical education organizations like the National Residency Matching Program, the Association of Medical Colleges, and the American Medical Association could take to reduce the frenzy:

• Coordinate interview timing: If student interviews could be consolidated into a predictable, cohesive season, educators could plan a meaningfully educational curriculum for the rest of the fourth year.

• Reduce or cap the number of interviews: If students could only take on a maximum of 10 interviews, they might be more thoughtful and selective about where they sent applications.

• A "screen and schedule" system: If residency programs employed online screening interviews before inviting applications in person, that could reduce unnecessary time and travel for students who don't become finalists.

Adashi and Gruppuso acknowledge that these suggestions may not take off, but ultimately call for more data on this topic to be gathered.

For more information: http://medicalxpress.com/news/2016-11-medical-professors-residency-placement-fever.html

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