Report provides a roadmap on improving the transition from medical school to residency

The transition from medical school to residency and all the time it entails can be overwhelming for students and residency programs alike. With more and more applications and interviews taking place virtually, students feel pressured to submit more applications, and the exponential increase is straining students and program directors alike.

“The process is currently very expensive, and there are more applicants than positions,” says Maura Biszewski, vice president of graduate medical education at the AOA. “There’s not very much transparency, and it’s a lot for fourth-year students to deal with while they’re also trying to finish the semester, do rotations and graduate.”

Biszewski is an AOA representative on the Coalition for Physician Accountability’s UME-GME Review Committee, a stakeholder group which released recommendations last year on how to simplify and improve the transition from medical school to residency.

In its report, the group, which includes representatives from the AOA, the NBOME, AACOM, the National Resident Matching Program and other stakeholder organizations, shared 34 core recommendations in the areas of applicant advising, diversity, equity and inclusion (DEI), away rotations, application review and selection processes, and wellness.

 Below, several members of the report’s review committee share their insights on improving the process on transitioning to residency, including details about the changes they feel will result in reduced stress for applicants and programs.  

Application inflation isn’t helpful for either side

Juhee Patel, DO, a PGY-1 in Pediatrics at Lehigh Valley Health Network – Reilly’s Children Hospital, who also took part in the committee, recalls how challenging and time-consuming the process of applying to residency was for her last year.

“I applied, interviewed, and accepted a residency position,” says Patel. “I experienced first-hand how stressful this process is. It’s expensive, time consuming, and high stakes. There is a lack of transparency and trust between the UME and GME ends of the same continuum. Going unmatched in the process is not an unrealistic outcome. Furthermore, learners are highly in debt and coming out of this long journey without a paying job is not a reasonable option. These and many more factors make this current transition a very stressful one.”

Dr. Patel agrees that application inflation is a big problem, citing that it increases costs for students, and stresses that residency programs do not have the resources to review thousands of applications for only a few positions. The inflation is one problem that needs to be addressed first, in order to directly create more real change, she says.

Another current problem is the lack of a single, verifiable and searchable database containing GME program information. Ideally, this would contain information about individual programs, as well as the characteristics of applicants who have applied to and been interviewed for each program, so applicants have a better idea of whether they’re competitive candidates for programs, Dr. Patel says.

“It’s complex, costly, and there is no single governing body to facilitate improvements,” says Elise Lovell, MD, Emergency Medicine Residency Program Director at Advocate Christ Medical Center. Dr. Lovell also served as the co-chair of the Coalition’s review committee. “There isn’t an easy first step. Consideration of the recommendations as a set of interconnected proposals will provide a more cohesive opportunity for improvement.

“It’s also important to consider that the process has multiple stakeholders, and therefore multiple efforts will be required to improve the transition for learners, residency program leadership, and medical school educators. An important first step is the commitment by stakeholders to collaborate to improve transparency, communication, and trust.”

Committee member Biszewski recognizes that for students, finding out what all needs to be done within the current process can take so much time.

“It gets to the point where students don’t get the time to even celebrate the changes they’re going through, and their accomplishments,” says Biszewski. “The pandemic really amplified the fact that the process isn’t working, and it’s giving the opportunity for us to pilot-run virtual interviews.”

Equity is paramount to achieving progress

As a part of the committee, Dr. Lovell believes there are opportunities to improve the quality and consistency of advising, and the information about programs and applicants provided to all involved, with the overall goal of optimizing the placement of applicants at programs where mutual interest is high.

As mentioned earlier, one recommendation calls for the creation of a single interactive database to house program information for applicants, medical schools, and residency programs. Currently, different information about programs is available across multiple different sites; a uniform database would help standardize the information available to all applicants about all programs.

“Equity and decreasing stress are paramount,” says Dr. Lovell. “Allowing applicants to have adequate time to respond to invitations, uniform invitation release dates, transparency about the process, not overbooking interviews (by programs) and not accepting multiple simultaneous interviews (applicants), are all relatively easy standards to implement.”

Implementing these standards would also help reduce application numbers, Dr. Lovell says.

Since the beginning on the COVID-19 pandemic, virtual interviews and tours have become more prevalent throughout the residency application process. Now, some are wary of allowing applicants to mix and match both virtual and in-person interviews and visits.

“It was a large consensus that interviewing should all stay consistent across the board,” says Dr. Patel. “It needs to be either all virtual or all in-person, but no hybrid models. We feel that there are too many equity problems that could arise with hybrid models, and disadvantaged students could potentially be further disadvantaged.”

Whether they have virtual or in-person interviews, each applicant still must try to find a way to find the best program for them. Dr. Patel recommends ranking from 1 to 5 the factors that are the most important to you, and keeping them in mind while going through the process.

The committee agrees there are opportunities to better support students throughout the process, including advising about alternative non-clinical career paths and providing realistic advising that helps minimize students’ chances of not matching.

For unmatched students, one recommendation is to conduct a study of what actually comprises a successful residency selection cycle and how it not only affects the unmatched applicants but also is related to our society’s physician workforce needs.

“(Making the process less stressful) is absolutely an achievable goal,” says Dr. Lovell. “We are at a pivotal moment where there is acknowledgement of the critical need for improvement of the UME-GME transition by educators, learners and stakeholder organizations. The work of the committee outlines ways forward, which will take collaboration and hard work, but will benefit all involved, and most importantly, the public good and health of our society.”

As a fellow committee member, Dr. Patel agrees wholeheartedly.

“This is only the first step in the process,” she says. “We still have a lot to accomplish and a lot to do.”