As I write this, medical students and residency program directors across the country are preparing their rank lists to submit to the National Resident Matching Program. With a disproportionate increase in graduating medical students relative to available residency positions, the process of applying, interviewing and waiting for Match Day, has become an anxiety-driven study in scarcity mentality. Students – at the urging of their medical schools, which stand to lose status if their students don’t match – apply to and interview at more and more programs every year, at a significant cost in terms of fees and travel expenses. Residency programs are overwhelmed by the growing number of applications and either expend enormous resources reviewing all of them or set a cut-off point for the United States Medical Licensing Exam (USMLE) scores and only review that subset of applicants. For General Surgery residencies, the estimated costs of recruiting were an average of $18,648 per position being filled.1
At the end of all of this, the Match is not identifying best fit as well as either side would like. There is a paucity of actionable data exchanged between students and programs to help make informed decisions as to how successful a student is likely to be as a resident in a given program. Good test-taking predicts good scores on subsequent tests, but not overall performance as a resident, and the use of cognitive-based assessment tools for screening has been shown to disproportionately impact under-represented in medicine applicants.2 Program Directors and residents deal with remediation at a very real cost in terms of time, effort and money. The highest price comes when a resident leaves a program, and this still occurs in up to 20% over five years of General Surgery residency.3
So, what is the answer? There is an entire professional discipline, Industrial-Organizational Psychology, that has developed data-driven processes for assessing best fit between applicants and a given position. These processes are informed by job task analysis, which identifies the specific attributes associated with successful performance of the job. For example, in a given residency program, the culture may be such that a great deal of initiative is seen in residents who are very successful. In a different program, the culture may favor someone who is more cautious and checks in with a senior resident or attending before implementing a care plan. I-O Psychologists develop and validate screening tools that assess for the characteristics needed for successful job performance; this can significantly decrease the bias that inevitably creeps into resident selection and improve the diversity and inclusion in residency programs.4
Fortunately, this science is beginning to find its way into residency selection. One study looked at a screening assessment tool and structured interview process informed by job task analysis and found significant improvements in the time and monetary expenses associated with fellowship interviews. Follow-up work to that study involving a consortium of General Surgery Residency Programs is underway.
Surgical leaders should pay attention – the old adage “Culture eats strategy for breakfast, lunch and dinner” rings true, and assessing applicants for cultural fit can be a strong tool in driving desired culture for the Department Chair or clinical program leader, not just the Program Director. The SUS Education Committee hosted a lunch session in the 2018 Academic Surgical Congress in which Dr. Brian Junker, an I-O Psychologist who teaches at the SUS Leadership Agility course, shared the science of selection and its application to Surgical Leadership. In a survey of SUS leaders completed by the committee, knowledge of selection science came up as a significant knowledge gap and interest in future educational activities. Look for more opportunities to learn how the field of Industrial-Organizational Psychology can help you as a surgical leader improve the effectiveness of the team you lead!
- Gardner AK, Smink DS, et al. How much are we spending on resident selection? J Surg Educ 2018;75(6):e85-e90
- Gardner AK, Grantcharov T, Dunkin BJ. The science of selection: Using best practices from industry to improve success in surgery training. J Surg Educ 2018;75(2):278-285
- Khoushhal Z, Hussain MA et al. Prevalence and causes of attrition among surgical residents: A systematic review and meta-analysis. JAMA Surg 2017;152(3);265-272
- Gardner AK. How can best practices in recruitment and selection improve diversity in surgery? Ann Surg 2018;267(1):e1-e2
