Repairing the Residency Application Process

Regardless of program competitiveness, program directors experience the application and interview period, from September through February rank list, as exhausting at best and as a nightmare at worst. Other work is neglected or given scant attention. Contacts know that faculty will be slow to respond and likely to miss meetings until the interview season is over. For program directors, the ongoing tension between goals and fears makes this potentially exciting time—meeting enthusiastic, bright individuals who are interested in their field—overly stressful.

A program director's goal is to rank and match students who can learn to provide great care of patients during and after residency, and perhaps reflect credit on their training through future good works. The program director's fears include matching students who disrupt the learning of other trainees, take excessive faculty time, cannot pass their boards, and harm patients, despite all efforts to provide them with the best training. Not matching a full cohort is an added worry that competes equally with these concerns. Now add to this mix unlimited applications by students, some of whom apply to every residency program in their desired specialty, and difficulty interpreting information provided by the medical schools that have evaluated these students for 4 years.

Program directors are drowning and need help.

From the medical student point of view, the fourth year is less of a time to explore diverse medical interests that often must be shelved during residency—electives in other key disciplines, public education, research, quality improvement, and writing—and more of a frantic scramble to complete applications, do “audition” electives, and check online, every few seconds, to see if an interview slot has opened up. Online blogs and websites,¹ including numerous for-profit sites, purport to teach students how to choose programs, obtain interviews, and write personal statements. The latter have morphed to “impersonal statements” according to some.² “Check out our new comprehensive guide to acing your medical residency interview and matching with the program of your dreams” offers one site.³ “Get 1-on-1 help with your ERAS application from a former Residency Program Director!” claims another.⁴

Medical students are drowning and need help.

If this situation were inescapable, so be it: program directors and students have been dealing with it, and they will survive. However, realistic solutions abound; many are described in the 4 following articles, written by different stakeholders: undergraduate medical education deans, a recent medical school graduate, a program director, and graduate medical education deans.

I recommend that you read their suggestions carefully and take a stand. Then, lobby for change within your various roles and responsibilities, so that the current process is improved. Through reasonable compromises and actions by all parties, this change starts now.