Perceived Barriers and Misconceptions Regarding Internal Medicine Residency Selection: A Pre–Post Survey Evaluation of a “Path to Specialization” Speed Dating Event

Abstract

Introduction

To explore transparency and address misconceptions regarding the selection of medical residents, the Internal Medicine Department of the Erasmus Medical Center, Rotterdam, The Netherlands, organized a “path to specialization” event. This event targeted medical bachelor’s and master’s students, PhD candidates, and junior doctors who consider a residency training in internal medicine. The event featured a plenary opening, followed by structured speed-dating sessions with internal medicine physicians and residents, fostering open discussions in an interactive question-and-answer format. In the current study, we evaluated the effects of this event on (mis)conceptions about selection procedures and explored whether it could help reduce perceived barriers.

Methods

Participants completed a full questionnaire before the event and a shortened post-event questionnaire repeating the three belief statements and two open-ended questions. The questionnaires were anonymous and therefore the statistical analyses were unpaired as the responses could not be linked.

Results

A total of 60 participants were included in the current study, of whom 38 (63%) reported obstacles in choosing internal medicine as their specialty of choice. Following the speed-dating sessions, participants reported greater perceived transparency and fewer misconceptions regarding residency selection compared with before the event. The median self-estimated likelihood of being accepted into an internal medicine residency increased from 6 (IQR 5–7) before the event to 7 (IQR 6–8) after the event (p<0.001). Agreement with the statement that “a PhD is required to enter internal medicine residency” decreased from 6 (IQR 5–7) to 4 (IQR 3–6) (p<0.01). Similarly, agreement with the statement that “outside the conurbation it is easier to enter internal medicine residency training” decreased from 6 (IQR 4–8) to 3 (IQR 2–4) (p< 0.0001). Additionally, participants identified key areas for improvement that could enhance the attractiveness of internal medicine as a specialty, including the need for a mentor or role model, with 38/60 attendees reporting this need (62%).

Discussion

Speed date sessions may represent a feasible approach to improving transparency, addressing misconceptions, and supporting prospective applicants in residency selection. Such interventions might be particularly valuable in systems with open, competitive selection such as the Netherlands, and may also help address application inflation in matching-based systems, such as in the United States, by aligning applicant expectations with selection processes. Longitudinal prospective studies are warranted to further evaluate the potential effects of this approach.

Plain Language Summary

• Improving transparency and accessibility of postgraduate medical training is increasingly important amid growing healthcare demand and workforce shortages driven by an aging population and workforce.

• Organizing a “path to specialization” event with speed dates may be an effective approach to increase transparency, lower barriers, and address misconceptions surrounding medical residency selection.

• The information session and speed dating events allow departments to identify what is important for potential applicants and consequently make their residency program more appealing.

Introduction

Medical education pathways and routes to residency differ substantially across different countries and medical specialties. However, one common denominator is that the career path to becoming a medical specialist is perceived as long and often competitive.

In the Netherlands, undergraduate education spans six years, divided into a three-year bachelor’s and a consecutive three-year master’s program.¹ Upon graduation, junior doctors can opt to work as a “resident-not-in-training” (RNIT) before applying for residency programs, to gain more work experience first.² Residency positions in the Netherlands are allocated based on open, competitive selection² and junior doctors with research experience, a PhD or a few years of clinical experience are at an advantage.³ However, obtaining a PhD is not a formal mandatory step for admission into residency training.

The Dutch hospital specialty residency selection procedure has been described as a “selection game”, with implicit and tacit rules, which the candidates are expected to know and adhere to.⁴ As suggested, this may be more problematic for underrepresented minorities, since familiarizing oneself with these implicit rules often requires social capital.⁴ Thus, increased understanding of and transparency regarding the selection procedure and its implicit rules would level the playing field for all candidates, increasing equality of opportunity.

In the United States, residency positions are allocated through a national matching system.^2,5 In recent years, the number of applications submitted per applicant has significantly risen, leading to a surge in review time for departments and costs for applicants.⁶ Increasing transparency regarding selection criteria has been proposed as a strategy to mitigate this growing number of applications submitted per applicant, by aligning applicants’ expectations with realistic opportunities.^5–8

Therefore, countries that use an open selection system as well as countries that use a match-based selection system would benefit from identifying ways to increase transparency in the residency selection process.

From this perspective, the Department of Internal Medicine (IM) of the Erasmus Medical Center (Erasmus MC) organized a “path to specialization” event, for all interested bachelor, master, and PhD students, as well as RNITs. The event included structured speed dating sessions with internal medicine physicians and residents, providing participants with the opportunity to ask questions about the application process, including required competencies, and work–life balance. Whilst speed dates have previously been used to improve understanding of a specialty,⁹ facilitate mentor-mentee pairing^10,11 and to provide career guidance,¹² it’s use in increasing transparency regarding residency selection remained unknown. The aim of this study is to evaluate whether such targeted informational interventions can improve perceptions of transparency and reduce perceived barriers to pursuing a career in internal medicine.

Methods

The study consisted of a single-center pre– and post-survey study at Erasmus MC University Medical Center, Rotterdam, the Netherlands, targeting all participants of the speed date event. The event took place in January 2026. Participants were invited via social media and direct emails from program directors and scientific mentors. The aim was to evaluate whether the speed date sessions could increase transparency regarding IM residency selection. This was assessed by asking i) whether any barriers were felt in choosing IM as a residency program, and if so, to specify the largest barriers, ii) to specify which aspects would make IM more attractive, and iii) to test whether the event affected self-estimated chances (scale 1–10, where 1 equals “not a chance” and 10 equals “certainly accepted”) of being accepted into IM residency, as well as to evaluate the persistence of 2 common misconceptions, namely that a PhD is required to enter residency training and that outside the conurbation it is easier to enter IM residency training.

The intervention consisted of a plenary session led by the IM program director, who provided general information about the IM residency selection process. This was followed by structured speed-dating sessions with IM physicians and residents, during which participants were assigned to small groups of 4–5 individuals and took part in four 15-minute sessions.

Before the event, participants were asked to complete a full anonymized questionnaire. This questionnaire also gathered baseline characteristics, such as current position, age and with which ethnicity the participants identified most. The ethnicities included some of the most common non-European ethnicities in the Netherlands, as well as an option to report an ethnicity not on the list or not to share this information. Directly after the event, participants completed a shortened version of the questionnaire, which repeated the three belief statements and two open-ended questions using identical wording (Supplementary Material 1.0), thereby capturing immediate shifts in stated beliefs, not durable changes.

Descriptive analyses were performed, and data were stratified by position. As the questionnaires were completed anonymously, individual pre- and post-event responses could not be linked. Therefore, pre- and post-event responses were compared using unpaired analyses.

For all statistical analyses, a Mann–Whitney U-test was used. The two-sided level of significance (alpha) was 0.05. All statistical analyses were performed using GraphPad Prism version 10.6.1 for Windows, GraphPad Software, Boston, Massachusetts USA, https://www.graphpad.com.

The Medical Ethics Review Committee of Erasmus MC University Medical Center, Rotterdam, the Netherlands, was consulted by Email prior to the study and determined that ethical approval was not required. Informed consent was implied by voluntary completion of the anonymous questionnaire.

Results

A total of 65 participants attended the event, of whom 60 (median age 23 years, interquartile range 21–26) completed the questionnaires before the sessions and 43 after. Baseline characteristics are presented in Table 1, which shows that most participants had a Dutch ethnic background and the largest group consisted of Master of Medicine students. Overall, 38/60 attendees (63%) experienced barriers to choosing IM as their specialty, as depicted in Table 2.

Table 1.

Baseline Characteristics of Respondents

Position (n; %)	Dutch Ethnicity (n; %)	Age in Years, Median (IQR)
RNIT (n=10; 17%)	(n=9; 90%)	26.5 (26.0–29.0)
Bachelor of Medicine student (n=14; 23%)	(n=8; 57%)	19 (19.0–20.0)
Master of Medicine student (n=24; 40%)	(n=14; 58%)	22 (22.0–24.0)
PhD student (n=12; 20%)	(n=7; 58%)	27 (25.5–28.5)
Total (n=60; 100%)	(n=38; 63%)	23 (21.0–16.0)

Table 2.

Participants’ Interest and Experienced Obstacles

Position (n; %)	Current Primary Interest in IM? (Yes) (n; %)	Do You Experience Barriers to Choosing IM as Your Specialty of Choice? (Yes) (n; %)
RNIT (n=10; 17%)	(n=9; 90%)	(n=6; 60%)
Bachelor of Medicine student (n=14; 23%)	(n=7; 50%)	(n=8; 57%)
Master of Medicine student (n=24; 40%)	(n=14; 58%)	(n=14; 58%)
PhD student (n=12; 20%)	(n=11; 92%)	(n=10; 83%)
Total (n=60; 100%)	(n=41; 68%)	(n=38; 63%)

The three largest barriers for attendees to choose IM as their specialty were “uncertain if I could get into IM training since it is difficult to get in”, “unclarity about how to get into training” and “lack of work-life balance” (Figure 1A). Among RNITs, uncertainty about acceptance appeared to be the most reported barrier, whereas the most reported barrier by PhD students regarded work-life balance concerns. Among participants who did not identify as Dutch, 3/22 (14%) reported a lack of diversity and inclusivity as a primary or secondary barrier.

Figure 1.

Bar plots depicting experienced obstacles and aspects that would make IM more attractive as a residency program. For both questions, respondents were asked to choose a maximum of two items. (A) Experienced barriers for choosing IM as their specialty, ordered from most to least experienced barriers, and stratified by position. Attendees could select a maximum of two of the following statements: unclarity about what work in IM entails, unclarity about how to get into training, assuming a PhD is required, idea of a too high workload, lack of diversity and inclusivity, uncertain if I could get into training, it’s hard, uncertainty about job prospects in IM (for example; employment), lack of work-life balance, IM is too broad, IM is not procedural/operative enough, lack of acute/technical aspects in IM and “other: … … ”, which was chosen once as “not being smart enough”. The numbers in the legend indicate the number of attendees who reported obstacles within that subgroup. (B) Aspects that would make IM more attractive according to respondents, stratified by position. Each segment within each column depicts the percentage of that choice among the total choices within the group (eg the option “more clarity and transparency about how you can enter residency training” was chosen 7 times by RNITs, within that subgroup total of 18 responses were given and therefore makes up 39% precent of the RNIT column.

Abbreviations: RNIT, resident not in training; IM, Internal Medicine.

Additionally, 37/60 attendees (62%) noted that a mentor or role model in IM would be helpful. 21/60 attendees (35%) did not know (yet) if they needed a mentor or role model in IM and only 2/60 attendees (3%) reported that they did not need either. Moreover, when asked what would make IM more attractive as a specialty, the three most frequently chosen replies were: “increase transparency about how to enter specialization”, “more focus on work-life balance”, and “better support for young doctors, via mentorship and guidance” (Figure 1B). These preferences also appeared to be frequently expressed among RNITs and PhD students, who are already close to applying for IM residency training.

Following the intervention, participants’ self-estimated likelihood of being accepted into IM residency increased from a median of 6 (IQR 5–7) before the event to 7 (IQR 6–8) after the event (p<0.001) (Figure 2A). Agreement with the statement that “a PhD is required to enter internal medicine residency” decreased from a median of 6 (IQR 5–7) to 4 (IQR 3–6) (p< 0.01) (Figure 2B), highlighting a persistent misconception before the event, as a PhD is not a formal requirement for entering residency training. Moreover, the median agreement with the statement “Outside the conurbation it is easier to enter internal medicine residency training” decreased from 6 (IQR 8–4) to 3 (IQR 4–2) (p< 0.0001) (Figure 2C).

Figure 2.

Box plots, showing responses before and after speed dates. (n=60 pre-intervention and n=43 post-intervention). **, ***, and **** indicate p ≤ 0.01, p ≤ 0.001 and p ≤ 0.0001 respectively. Statistical testing was done using a mann-whitney U-test (A) Self-estimated likelihood of being accepted into IM residency training on a scale from 1 to 10, where 1 equals “not a chance” and 10 equals “certainly accepted”. (B) Agreement with the statement “a PhD degree is required to enter internal medicine residency” on a scale from 1 to 10, where 1 equals “absolutely disagree” and 10 equals “absolutely agree”. (C) Agreement with the statement “outside the conurbation it is easier to get into internal medicine residency” on a scale from 1 to 10, where 1 equals “absolutely disagree” and 10 equals “absolutely agree”.

The post-intervention increase in self-estimated acceptance chances may reflect reduced uncertainty about acceptance into IM residency training. Similarly, the post-intervention decrease in agreement with the misconception that a PhD is required for IM residency training may indicate reduced perceived barriers related to this assumption. Participants additionally indicated in their response to the open questions (Supplementary Material 2.0) that they were interested in more detailed information on differences between academic and non-academic training, the different training hospitals, selection criteria, and application success rates.

Discussion

To the best of our knowledge, this study is among the first to evaluate that an information session, followed by a speed dating event, was associated with improved perceived transparency of IM residency selection and reduced misconceptions among prospective applicants. While similar initiatives have been described to provide guidance on career and residency application,¹² improve understanding of a specialty,⁹ and facilitate mentorship exploration,^10,11 empirical evidence regarding their impact on perceived transparency and selection-related misconceptions remains limited.

Our results show that organizing speed dates focused on increasing transparency in residency selection may be effective at lowering barriers for interested prospective applicants. Interestingly, our descriptive results suggest that those already closest to applying to IM training, particularly RNITs and PhD students, frequently reported the need for transparency around specialization and the mentorship. A major strength of this intervention is the active involvement of program directors themselves, which may reduce the perceived barriers between participants and those involved in selection.

Several limitations exist in this study. First, this was a single-center study, and results may not be generalized to other specialties and centers. However, the candidates for this event also originated from outside the region of Rotterdam. Second, the pre-post design of the study without a control group does not permit any conclusions regarding the long-term success rate of the event. Moreover, the post-event questionnaire took place directly after the event and the results reflect an immediate shift in stated beliefs, not durable changes. Longitudinal data are warranted to determine whether such events lead to a more diverse pool of candidates applying for IM, accompanied by improvements in the fairness of selection procedures. Third, not all participants completed both the pre- and post-event questionnaires, introducing potential attrition bias. The post-event questionnaire was a shortened version of the pre-event questionnaire, repeating only the three belief statements and two open-ended questions using identical wording. As participant characteristics were not collected in the post-event questionnaire, differences in sample composition between the pre- and post-event samples could not be assessed.

Despite these limitations, our findings have practical implications. For departments operating within competitive, open selection systems, improving transparency and access to mentorship may lower perceived barriers and support more informed career decision-making. Similar interventions may also be relevant in matching-based systems, such as in the USA, where increased clarity around selection criteria could help address overapplication by aligning applicants’ expectations with realistic opportunities.^5–8

In addition, our findings provide important insights into which aspects of the selection and orientation process might require further improvement, which can also be relevant for other medical specialty training programs. At a time of increasing healthcare demands and workforce shortages driven by an aging population and workforce, attracting and supporting medical students and junior doctors to pursue postgraduate training in IM is of increasing importance.

Future research is needed to assess the long-term impact of these interventions on application behavior and specialty choice. In addition, further work is needed to determine how informational and mentorship initiatives can be best tailored to different stages of medical training.

In conclusion, structured “path to specialization” events, including a speed date event, may represent a feasible approach to improving transparency, addressing misconceptions, and supporting prospective applicants in navigating the transition to residency training.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.