C. Ray is a second-year resident in internal medicine and pediatrics, Virginia Commonwealth University, Richmond, Virginia. S.E. Bishop is assistant professor of internal medicine and clerkship director, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia. A.W. Dow is Ruth and Seymour Perlin Professor of Internal Medicine and Health Administration and assistant vice president of health sciences for interprofessional education and collaborative care, Virginia Commonwealth University, Richmond, Virginia; ORCID: http://orcid.org/0000-0002-9004-7528.
Acad Med. 2018 Jan;93(1):45-47. doi: 10.1097/ACM.0000000000001781.
Since the 1950s, the National Resident Matching Program, or "the Match," has governed the placement of medical students into residencies. The Match was created to protect students in an era when residency positions outnumbered applicants and hospitals pressured students early in their academic careers to commit to a residency position. Now, however, applicants outnumber positions, applicants are applying to increasing numbers of programs, and the costs of the Match for applicants and programs are high. Meanwhile, medical education is evolving toward a competency-based approach, a U.S. physician shortage is predicted, and some researchers describe a "July effect"-worse clinical outcomes correlated with the mass entry of new residents.Against this background, the authors argue for adopting a more modern, free-market approach to residency matchmaking that might better suit the needs of applicants, programs, and the public. They propose allowing students who have been identified by their medical schools as having achieved graduation-level competency to apply to residency programs at any point during the year. Residency programs would set their own application timetables and extend offers in an ongoing fashion. Students, counseled by their schools, would accept or decline offers as desired. The authors argue this approach would better support competency-based education while allowing applicants and programs more choice regarding how they engage and adapt within the selection process. The approach's staggered start times for new residents might attenuate the July effect and improve outcomes for patients. Medical students might also enter and thereby complete residency earlier, increasing the physician workforce.
自 20 世纪 50 年代以来，国家住院医师匹配项目（简称“匹配”）一直负责将医学生安置到住院医师岗位。该匹配的创建是为了在住院医师岗位多于申请人且医院在学生学术生涯早期向他们施压要求承诺从事住院医师岗位的时代保护学生。然而，现在申请人多于岗位，申请人正在向越来越多的项目申请，而且申请人和项目的匹配成本很高。与此同时，医学教育正在向基于能力的方法发展，预计美国将出现医生短缺，一些研究人员描述了一种“7 月效应”-大量新住院医师入职与临床结果恶化相关。在这种背景下，作者主张采用一种更现代、更自由的市场方法来进行住院医师匹配，这可能更符合申请人、项目和公众的需求。他们建议允许那些已经被医学院确定为达到毕业水平能力的学生在一年中的任何时候申请住院医师项目。住院医师项目将自行设定申请时间表，并以持续的方式提供录取。学生们将在学校的指导下根据自己的意愿接受或拒绝录取。作者认为，这种方法将更好地支持基于能力的教育，同时允许申请人和项目在参与和适应选拔过程方面有更多的选择。新住院医师的交错入职时间可能会减轻 7 月效应并改善患者的预后。医学生也可能更早地进入并完成住院医师培训，从而增加医生劳动力。
