An Outcomes-Oriented Approach to Residency Selection: Implementing Novel Processes to Align Residency Programs and Applicants

Abstract

Residency application numbers have skyrocketed in the last decade, and stakeholders have scrambled to identify and deploy methods of reducing the number of applications submitted to each program. These interventions have traditionally focused on the logistics of the application submission and review process, neglecting many of the drivers of overapplication. Implementing application caps, preference signaling as described by Pletcher and colleagues in this issue, or an early Match does not address the fear of not matching that applicants hold, the lack of transparent data available for applicants to assess their alignment with a specific program, or issues of inequity in the residency selection process. Now is the time to reconsider the residency selection process itself. As competency-based medical education emerges as the predominant educational paradigm, residency selection practices must also shift to align with societal, specialty, and program outcomes. The field of industrial and organizational psychology offers a multitude of tools (e.g., job analysis) by which to define the necessary outcomes of residency training. These tools also provide programs with the infrastructure around which to scaffold an outcomes-oriented approach to the residency selection process. Programs then can connect residency selection to training outcomes, longitudinal assessment modalities, and the evolving learning environment. To achieve an outcomes-oriented residency selection process, stakeholders at all levels will need to invest in coproducing novel ways forward. These solutions range from defining program priorities to implementing national policy. Focusing on outcomes will facilitate a more transparent residency selection process while also allowing logistics-level interventions to be successful, as applicants will be empowered to better assess their alignment with each program and apply accordingly.

Dismissed Psychiatry Residents Who Appeal: Exploring Unprofessional Behavior

“…Aptitude for these domains might deserve extra attention during selection procedures. Therefore, selection procedures for postgraduate training positions may include tools to assess residents on professionalism, judgment, and communication, such as the multiple mini-interview [ 34 ], the situation judgment test [ 35 ], and other tools from industrial and organizational psychology [ 36 ], in addition to reference checking. However, none of these tools have sufficient positive and negative predictive power regarding a priori identification of structural patterns of either professionalism or unprofessionalism.…”

The Big Data Gap: Asymmetric Information in the Ophthalmology Residency Match Process and the Argument for Transparent Residency Data

“…Per Accreditation Council for Graduate Medical Education (ACGME), residents are required to demonstrate competence as the primary surgeon in a number of surgeries in order to graduate, including cataract, cornea, glaucoma, globe trauma, oculoplastics/orbit, retinal/vitreous, strabismus, and laser procedures (e.g., YAG capsulotomy, laser trabeculoplasty, laser iridotomy, panretinal laser photocoagulation). 13 However, despite clear guidelines on achieving competence in specific surgeries, the data provided on surgical volume was varied and occasionally did not meet the definition of achieving competence. Interestingly, while an overwhelming majority of programs were able to provide resident surgical volume on SFMatch, only 21% provided any data on surgical volumes on their home Web site.…”

Residency Selection in Otolaryngology: Past, Present, & Future

“…By merging the selection science expertise of I‐O psychologists with the contextual experience of the medical education community, exciting innovations in selection system design for postgraduate training have been achieved abroad 11 . Fortunately, similar collaborations are also gaining momentum in the United States, including those within surgical disciplines 12–14 …”