Residency Programs’ Selection Criteria Selection Criteria for Residency: Results of a National Program Directors Survey

Purpose To assess the relative importance of criteria used for residency selection in 21 medical specialties given current available data and competitiveness of specialties. Method In 2006, questionnaires were distributed to 2,528 program directors in university hospital or university-affiliated community hospital residency programs across 21 medical specialties. Responses were recorded using a five-point Likert scale of importance. Mean values for each item were calculated within and across all specialties. Mean scores for item responses were used to create rank orders of selection criteria within the specialties. To facilitate comparisons, specialties were grouped according to the percentages of positions filled with U.S. medical school graduates. Results The overall response rate was 49%. With the data from all specialties pooled, the top five selection criteria were (1) grades in required clerkships, (2) United States Medical Licensing Examination (USMLE) Step 1 score, (3) grades in senior electives in specialty, (4) number of honors grades, and (5) USMLE Step 2 Clinical Knowledge (CK) score. Conclusions The top academic selection criteria are based on clinical performance, with the exception of USMLE Step 1 score. Indicators that reflect excellence in clinical performance are valued across the specialties by residency program directors regardless of competitiveness within the specialty. USMLE Step 2 CK ranks higher in the less competitive specialties, whereas research experience is more prominent in the most competitive specialties. The Medical Student Performance Evaluation was ranked lowest of all criteria by the program directors. Acad Med. 2009; 84:362–367. Medical student educators are aware of the anxieties and uncertainties facing students who are applying for residency positions. The National ResidentMatch Program (NRMP)/Association of American Medical Colleges (AAMC) publication, Charting Outcomes in theMatch,1 attempts to provide information regarding variables that predict success for students to match in their preferred specialties. Variables included in this analysis were the number of programs that a student ranks, Alpha Omega Alpha (AOA)membership, United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores, and research experience. There is little current information about how residency program directors rate the relative importance of additional available student data, such as preclinical grades, theMedical Student Performance Evaluation (MSPE, or former dean’s letter), the USMLE Step 2 Clinical Skills (CS) exam, and clinical grades. Myths and rumors abound regarding what is really important to program directors and their selection committees about desirable applicants. Themost recent comprehensive survey of program directors’ residency selection criteria was reported byWagoner and Suriano2 in AcademicMedicine in 1999. In this study, questionnaires were sent to 1,200 of the 3,494 program directors (approximately 34%) in 14 specialties. Wagoner and Suriano found that some selection criteria were emphasizedmore heavily than others and that the emphasis varied according to the competitiveness of the specialty. Several smaller surveys exploring selection criteria within specific specialties also have been published.3–13 Since publication of these earlier studies, additional information has become available to residency program directors and selection committees as they evaluate medical student applications to their programs. The implementation of the National Board ofMedical Examiners USMLE Step 2 CS examination in 2004 offers the potential to validate the clinical skills of applicants. Furthermore, the USMLE Step 2 Clinical Knowledge (CK) examination is now computerized and can be taken at any time, so scores are available to program directors at the time of application. The AAMC’s recommended template for theMSPE has standardized the traditional dean’s letter. Moreover, the competitiveness of many specialties has changed since 1999. The primary purpose of this study was to assess residency program directors’ opinions about the relative importance of various selection criteria in their specialties in 2006.We extended our analysis to other specialties that were not part of previous reports, surveying a total of 21 specialties. With this study, we hope to provide an updated andmore detailed perspective of the residency selection process and to highlight possible misperceptions that may affect student advising for residency application.