Introduction ii Copyright ©2018 NRMP. Reproduction prohibited without the written permission of the NRMP. Background The first edition of Charting Outcomes in the Match was published in August 2006 to document how applicant qualifications affect success in the Main Residency Match®. The report was published biennially between and 2011 and was a collaboration of the National Resident Matching Program® (NRMP®) and the Association of American Medical Colleges® (AAMC®). Match outcome data from the NRMP were combined with applicant characteristics from the AAMC's Electronic Residency Application Service (ERAS®) and United States Medical Licensing Examination (USMLE®) scores from the AAMC data warehouse. In 2014, NRMP added a Professional Profile section to its Match registration process to collect USMLE scores and other applicant characteristics and those have been used to independently publish all subsequent Charting Outcomes in the Match reports. Prior to 2016, this report examined the Match success of only two applicant groups: senior students from U.S. allopathic medical schools and independent applicants. Independent applicants included all applicant types other than U.S. seniors: previous graduates of U.S. allopathic medical schools, students/graduates of osteopathic medical schools, students/graduates of Fifth Pathway programs, students/graduates of Canadian medical schools, and U.S. citizen and non-U.S. citizen students/graduates of international medical schools. Because independent applicants are a heterogeneous group, a decision was made in 2016 to report data separately for U.S. allopathic medical school seniors, students/graduates of osteopathic medical schools, U.S. citizen students/graduates of international medical schools, and non-U.S. citizen students/graduates of international medical schools. In 2018, senior students of osteopathic medical schools are reported separately, and there is no report for osteopathic medical school graduates because their numbers are so small. This report examines the characteristics of U.S. allopathic seniors.

Background: Seymour fractures in children are prone to complications without prompt and appropriate treatment. This study investigated outcomes of Seymour fractures with delayed presentations; specifically, if deep infection predisposed to operative treatment, if antibiotic administration improved fracture healing, and if oral clindamycin had fewer treatment failures than oral cephalexin. Methods: A single-institution retrospective cohort study was performed of patients with delayed Seymour fracture presentations (defined as greater than 24 hours post-injury) between 2009 and 2017. Data collected included demographics, time to presentation, infection on presentation, operative treatment, antibiotic use and duration, fracture union, and complications. Statistical testing used logistic regression and Fisher’s exact test, with results reported as P-values ( P), odds ratios (ORs), and 95% confidence intervals (CIs). Results: There were 73 patients with delayed Seymour fracture presentations, with mean age of 11.1 years (standard deviation: 2.9), with 56 (77%) males, and median time to presentation of 7 days (interquartile range: 3-17). Deep infection on presentation was a risk factor for operative intervention (OR = 34.4, P = .0001, CI, 5.5-217.2). Antibiotic administration protected against the development of a nonunion or delayed union (OR = 0.11, P = .008, CI, 0.021-0.57). Time to antibiotics did not protect against nonunion or delayed union (OR = 0.77, P = .306, CI, 0.37-1.3). Clindamycin had fewer treatment failures than cephalexin ( P = .039). Conclusions: Deep infection is a risk factor for operative treatment of Seymour fractures with delayed presentations. Clindamycin is a better antibiotic choice for Seymour fractures that present in delayed fashion.

Background: Incomplete patient follow-up is a common problem after hand and upper extremity (HUE) surgery and is influenced by many demographic factors. The aims of this investigation are to determine patient-stated factors for lack of follow-up, identify potential interventions, and measure satisfaction following operations. Methods: A prospective survey sampling of 173 of 655 patients lost to follow-up after HUE operations in a single institution between June 2014 and July 2015 was performed. Demographic variables collected included age, sex, distance to clinic, insurance payor, and length of time to last follow-up visit. Survey responses regarding reasons for insufficient follow-up, future recommendations, and overall satisfaction were recorded. Statistical results were reported as P values, odds ratios (ORs), and 95% confidence intervals (CIs). Results: More than half (65.3%) of 173 patients erroneously thought that they had completed follow-up, with private insurance being the only risk factor (OR = 2.45, P = .010, 95% CI = 1.24-4.85). Other common reasons for insufficient follow-up included not placing the appointment into a personal calendar (7%), excessive costs (6%), and transportation (5%). Approximately half (51%) of 55 patients aware that they had missed follow-up stated that no intervention would have helped. Median patient satisfaction with their operation was 10/10 (interquartile range = 8-10). Conclusions: Most patients lost to follow-up after HUE operations were not aware that they had a follow-up appointment, but were nevertheless satisfied with treatment. Interventions targeted to patients who erroneously thought they had followed up may be the most beneficial.

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