Adams Alexander J, Sherman Matthew, Purtill James J
Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
JB JS Open Access. 2023 Jan 19;8(1). doi: 10.2106/JBJS.OA.22.00084. eCollection 2023 Jan-Mar.
Interviews are a critical component of orthopaedic surgery residency selection for both the applicant and the program. Some institutions no longer report Alpha Omega Alpha (AOA) designation or class rank, and US Medical Licensing Examination (USMLE) Step 1 recently switched to pass/fail scoring. During the coronavirus disease 2019 (COVID-19) pandemic, all Accreditation Council for Graduate Medical Education programs conducted virtual interviews and subinternship rotations were restricted. These changes offer significant challenges to the residency match process. The purpose of this study was to examine the residency applicant interview and ranking process at a large urban academic university setting. We hypothesized that large variability exists among evaluations submitted by faculty interviewers and also that applicant academic factors (i.e., USMLE Step 1 score) would show association with final ranking.
We retrospectively reviewed the 2020-2021 and 2021-2022 residency interview cycles, both conducted virtually due to the COVID-19 pandemic. Residency application (i.e., applicant demographic and academic backgrounds) and interview data (i.e., faculty interviewer scores) were recorded. Interobserver reliability among faculty interviewers was calculated. Statistical analysis was performed to determine factors associated with ranking of applicants.
There were 195 included applicants from the 2020 and 2021 interview cycles. There was no true agreement of interviewers' scoring of shared applicants (kappa intraclass coefficient range 0-0.2). Applicant factors associated with being ranked include applying to the match for the first time, USMLE Step 1 and 2 scores, educational break (vs. consecutive completion of college and medical school in 4 years each), higher class rank, and greater interviewer scores. Factors associated with better rank included additional degrees (i.e., PhD or MBA), couples match, AOA designation, educational break, underrepresented minority status, and notable attributes (i.e., collegiate athletics or Eagle Scout participation). Factors associated with worse rank included male sex, international medical graduate, prior match history, science major, extended research (i.e., >1 year spent in a research role), and home medical school students.
There was significant variability and no reliability at our institution among faculty interviewers' applicant ratings. Being ranked was based more on academic record and interview performance while final rank number seemed based on applicant qualities. The removal of merit-based objective applicant measurements offers challenges to optimal residency applicant and program match.
III (retrospective cohort study).
面试是骨科住院医师选拔过程中对申请者和项目都至关重要的环节。一些机构不再报告美国医学优等生协会（AOA）的指定或班级排名，并且美国医学执照考试（USMLE）第一步最近改为通过/失败计分制。在2019冠状病毒病（COVID-19）大流行期间，所有研究生医学教育认证委员会的项目都进行了虚拟面试，并且实习前轮转受到限制。这些变化给住院医师匹配过程带来了重大挑战。本研究的目的是在一个大型城市学术医疗中心环境中，考察住院医师申请者的面试和排名过程。我们假设教员面试官提交的评估之间存在很大差异，并且申请者的学术因素（即USMLE第一步成绩）将与最终排名相关。
我们回顾性地审查了2叭0 - 2021年和2021 - 2022年的住院医师面试周期，这两个周期均因COVID - 19大流行而以虚拟方式进行。记录住院医师申请（即申请者的人口统计学和学术背景）和面试数据（即教员面试官的评分）。计算教员面试官之间的观察者间信度。进行统计分析以确定与申请者排名相关的因素。
2020年和2021年面试周期中有195名申请者被纳入研究。面试官对共同申请者的评分没有真正的一致性（组内相关系数范围为0 - 0.2）。与被排名相关的申请者因素包括首次参加匹配、USMLE第一步和第二步成绩、教育中断（与连续4年分别完成本科和医学院学业相比）、较高的班级排名以及更高的面试官评分。与更好排名相关的因素包括额外学位（即博士或工商管理硕士）、夫妻匹配、AOA指定、教育中断、代表性不足的少数族裔身份以及显著特征（即参加大学体育活动或成为鹰级童子军）。与较差排名相关的因素包括男性、国际医学毕业生、既往匹配历史、理科专业、长期研究（即担任研究角色超过1年）以及本校医学院学生。
在我们机构，教员面试官对申请者的评分存在显著差异且不可靠。被排名更多地基于学术记录和面试表现，而最终排名顺序似乎基于申请者的特质。去除基于成绩的客观申请者衡量标准给实现最佳住院医师申请者与项目匹配带来了挑战。
III（回顾性队列研究）。
