Differences in the Academic Attributes of Matched and Unmatched Orthopaedic Surgery Residency Applicants are Narrowing

Abstract

Background:Orthopaedic surgery remains one of the most competitive residency specialties, with the number of applicants outpacing the availability of residency positions each year. The purpose of this study was to analyze present-day orthopaedic surgery match data, identify differences between matched and unmatched applicants, and compare our findings to previous trends.Methods:Applicant data from the National Resident Matching Program from 2016 to 2022 were analyzed. The number of matched and unmatched US allopathic senior orthopaedic applicants relative to the number of available positions was used to determine respective match rates. Performance metrics and applicant characteristics were compared by match status. Trends were compared with those of previous analysis from 2006 to 2014.Results:The number of applicants increased from 863 in 2016 to 1,068 in 2022. The match rate decreased from 75% in 2016 to 66% in 2022 (p < 0.0001). Matched applicants had a higher number of contiguous ranks (12.3 vs. 6.5; p < 0.001), United States Medical Licensing Examination (USMLE) Step-1 score (248 vs. 240; p < 0.001), USMLE Step-2 score (255 vs. 247; p < 0.001), Alpha Omega Alpha (AOA) membership (38% vs. 13%; p < 0.001), and enrollment at a top 40 National Institutes of Health (NIH)-funded medical school (34% vs. 24%, p < 0.001). Compared with 2006 to 2014 data, a smaller percentage of matched applicants were enrolled in a top 40 NIH-funded medical school (34% vs. 37%, p = 0.013). The mean differences in USMLE Step-1 score (16 vs. 8.25 points, p < 0.001) and USMLE Step-2 score (16 vs. 8.25 points, p = 0.002) in favor of matched applicants nearly halved compared with that in 2006 to 2014. In addition, there was no longer a significant difference in the number of research products (abstracts, presentations, posters, and publications) between matched and unmatched applicants (p = 0.309).Conclusions:Differences in the academic attributes of matched and unmatched orthopaedic surgery applicants have become less profound over time, making it increasingly difficult to predict a successful match based on USMLE Step scores, AOA membership, research productivity, and medical school research reputation. Future studies should evaluate differences in subjective metrics (e.g., away rotation and interview performance and letters of recommendation) by match status.

Understanding the Match: The Effect of Signaling, Demographics, and Applicant Characteristics on Match Success in the Orthopaedic Residency Application Process

“…10,11 In comparing our study with these results, we assume applicants attend each interview offer they receive and rank each program they interview at, however, given the competitive nature of the orthopaedic surgery match this assumption is likely to hold true in a great majority of cases. Furthermore, Sudah et al 12 found matched students had 7.7 volunteer experiences compared with 7.0 in unmatched; nearly, the same as the 7.61 and 7.05 volunteer experiences we found in matched and unmatched applicants. These similarities provide confidence that our results are valid and can be generalized to the entire orthopaedics' applicant pool.…”

“…Rynecki et al 10 found matched applicants to have a mean USMLE step 1 score of 248 and USMLE step 2 score of 255 compared with a mean USMLE step 1 score of 240 and USMLE step 2 score of 246 in unmatched applicants. In addition, Sudah et al 12 found mean USMLE step 1 and 2 scores to be 248 and 255, respectively, in matched applicants and 240 and 247 in unmatched applicants. These results are similar to our findings.…”

“…score of 246 in unmatched applicants. In addition, Sudah et al 12 found mean USMLE step 1 and 2 scores to be 248 and 255, respectively, in matched applicants and 240 and 247 in unmatched applicants. These results are similar to our findings.…”

“…The applicant characteristics predictive of match success in orthopaedic surgery have been studied in some detail and include United States Medical Licensing Examination (USMLE) step 1 and step 2 Clinical Knowledge (CK) scores, number of honored clerkships, Alpha Omega Alpha (AOA) membership, and number of peer-reviewed publications, metrics which have been found to differ markedly between matched and unmatched applicants. 10-12…”

“…3,4,8,9 The applicant characteristics predictive of match success in orthopaedic surgery have been studied in some detail and include United States Medical Licensing Examination (USMLE) step 1 and step 2 Clinical Knowledge (CK) scores, number of honored clerkships, Alpha Omega Alpha (AOA) membership, and number of peer-reviewed publications, metrics which have been found to differ markedly between matched and unmatched applicants. [10][11][12] Using the STAR database, this study aims to analyze the PSPs' effect on the orthopaedic surgery match, paying particular attention to whether the PSP seems to be achieving its goals and how the use of a signal compares with other applicant metrics. Given that orthopaedics allows its applicants the largest number of signals of any specialty and that many orthopaedic program directors do not think that the PSP will decrease applications, 13 we think quantifying the effects of the PSP will be of great interest to those involved with the match process.…”