A Comparison of Residency Applications and Match Performance in 3-Year vs 4-Year Family Medicine Training Programs

Abstract

Background and Objectives: The optimal length of residency training in family medicine is under debate. This study compared applicant type, number of applicants, match positions filled, matched applicant type, and ranks to fill between 3-year (3YR) and 4-year (4YR) residencies. Methods: The Length of Training Pilot (LOTP) is a case-control study comparing 3YR (seven residencies) and 4YR (six residencies) training models. We collected applicant and match data from LOTP programs from 2012 to 2018 and compared data between 3YR and 4YR programs. National data provided descriptive comparisons. An annual resident survey captured resident perspectives on training program selection. Summary statistics and corresponding t-tests and χ2 tests of independence were performed to assess differences between groups. We used a linear mixed model to account for repeated measures over time within programs. Results: There were no differences in the mean number of US MD, US DO, and international medical graduate applicants between 3YR and 4YR programs. Both the 3YR and 4YR programs had a substantially higher number of US MD and DO applicants compared to national averages. The percentages of positions filled in the match and positions filled by US MDs, DOs and IMGs were not different between groups. The percentage of residents in 4YR programs who think training in family medicine requires a fourth year varied significantly during the study period, from 35% to 25% (P<.001). The predominant reasons for pursuing training in a 4YR program was a desire for more flexibility in training and a desire to learn additional skills beyond clinical skills. Conclusions: The applicant pool and match performance of the residencies in the LOTP was not affected by length of training. Questions yet to be addressed include length of training’s impact on medical knowledge, scope of practice, and clinical preparedness.

Shaping the Future of Family Medicine: Reenvisioning Family Medicine Residency Education

“…Over the last 7 years, there has been a formal trial of 3 vs 4 years duration of family medicine residencies; long-term outcomes are now beginning to be published, with initial papers on admissions and finances. [37][38][39] Alan Douglass, MD, and Donald Woolever, MD, present a point/ counterpoint on this issue. 40 Warren Newton, MD, MPH, broadens the discussion by describing best practices from other specialties, including more substantial individual learning plans in pediatrics, oral examinations to assess judgment and complex decision making in many specialties and a phase of education and support for 1-2 years after residency.…”

Training Toward Our Future: Questions About Length of Training in Family Medicine Programs

“…The Length of Training Pilot (LOTP), an extensive case-control study with robust participation, is underway to explore the impact of longer training for family physicians with a focus on scope of practice, clinical skills, and trainee satisfaction. 1 While the initial results from Eiff, et al 1 on applicant characteristics and match results do not demonstrate significant differences in recruitment between 3-year and 4-year programs, it is clear that the true impact of extending family medicine residency remains undetermined, especially regarding the recruitment of women, underrepresented minority (URM) candidates, and applicants with substantial medical debt.…”

What Family Medicine Can Learn From Other Specialties

“…We have several options. The Length of Training pilot program [7][8][9] has shown the potential value of a fourth year of residency and has helped grow support for adding a fourth year, but still only a minority of residency program directors, faculty, and residents support it. 10,11 Traditional Accreditation Council for Graduate Medical Educationaccredited fellowships such as sports medicine, hospice and palliative medicine, or geriatrics might also count, as would any of the myriad of informal extra-year fellowships such as faculty development, maternity care, or hospitalist care that exist now or could be developed.…”