Principal Results
The factors that respondents find most helpful in deciding which residency programs to apply to differ by educational background (US-MD, DO, and IMG), but the most highly sought are around USMLE or COMLEX Step 2 scores, hometown regions of residents, and the racial or ethnic background of residents and attendings. Some of this information is available on databases like the Fellowship and Residency Electronic Interactive Database (FREIDA) [27], the Orthopaedic Residency Information Network (ORIN) [28], and program websites, but some of it is outdated [18-21]. Given that some programs screen applications by test scores [1,5,9], it would be helpful for applicants to have updated information about a program’s review criteria. Geographic preferences may also play a large role in the match process [29]. For the 2021 Match, there was a significant increase in matched applicants to their home orthopedic surgery and integrated plastic surgery programs [30,31]. Additionally, programs likely consider that more than half of residents practice where they train [32]. Consequently, increased transparency about geographic interests as an optional addition to the application could benefit programs to improve resident retention over time and for applicants to show interest in specific areas of the country. In the Match 2023, a total of 16 specialties asked about geographic preferences in the supplemental application, and program directors expressed positive feedback on its inclusion [33,34]. As of the Match 2024, the optional geographic interests section has been expanded to all specialties, representing an initial step in allowing applicants to express interest in those programs who consider geography important in their decision-making process.
Structural racism persists in medical training and match processes [35]. Residents and attendings who identify as URiM routinely experience bias at work and are relied on to fulfill a lack of standardized systems to promote diversity [36]. Although a higher percentage of URiM respondents selected the percentage of URiM faculty and residents as important in assessing fit, many non-URiM applicants selected it, too. Both groups likely value a safe and inclusive work environment for themselves or their colleagues. It is important to recognize various intersectional aspects of diversity, equity, and inclusion in the match to mitigate perceived (and real) risk for applicants; however, there is little best practice data for programs to counteract inequities of the application process. Some strides toward greater equity and inclusivity for the match include the addition of pronouns to the Electronic Residency Application Service. In addition, some programs may choose to screen out identifiers such as date of birth, headshots, and hometown when reviewing applications [37]. While additional data can benefit applicants, it can also help advisors provide tailored information. Metrics such as test scores, clinical grades, and experiences from previous applicants can be used to guide applicants on programs to apply to. This method of advising can help applicants strategically apply where they are likely to match, which may decrease anxiety, expense, and overapplying [38]. Growing internal and external databases like FREIDA [27] or the Texas Seeking Transparency in Application to Residency (STAR) [39], which contain aggregated data from recently matched medical students, can provide additional guidance. Expanding access to the Texas STAR by removing the requirement that medical schools must share their data to gain access and increasing IMG-affiliated medical schools’ participation, may increase transparency and improve match outcomes. Expanding specialty-specific databases to all specialties would be helpful, like ORIN [28] for orthopedic surgery and the Alignment Check Index [40] for obstetrics and gynecology. Using information from this study, updating these databases with the information applicants are most interested in may provide a better assessment of applicant fit and decrease overapplying. In addition to the percentage of URiM residents and attendings, which applicants selected as a helpful factor, programs can update their website and centralized databases with greater diversity, equity, and inclusion content [41], including information about URiM away rotation scholarship opportunities [42].