Over the last decade, the number of medical residency applications submitted by hopeful candidates has grown exponentially.

According to the American Association of Medical Colleges, the number of applications submitted by medical students seeking to match into obstetrics and gynecology programs grew to an average of 72 in 2021.

While many may assume that this significant growth is normal due to the highly competitive nature surrounding the residency application process, experts note otherwise.  

"It's startling to see how many fourth-year medical students are overapplying to residency programs. The number of open positions is still the same, but there are multifactorial reasons why the application numbers keep growing," said Helen Kang Morgan, M.D.,  professor of obstetrics and gynecology and learning health sciences at the University of Michigan Medical School. "For example, some students may feel extra pressure to overapply to programs just in case their first or second choices don't work out. And there are very few incentives for them to do anything differently. In addition, students know that the percent of applicants who match into one of their top ranked positions continues to decrease."

Morgan is a co-investigator and program evaluation lead for the Association of Professors of Gynecology and Obstetrics, or APGO, AMA Reimagining Residency Grant, "Right Resident, Right Program, Ready Day One." The grant aims to encourage initiatives like creating a more holistic review process for residency applicants and advocating for an early result acceptance program to help alleviate the excessive number of applications submitted each year. 

The primary-investigator for the grant, Maya Hammoud, M.D., M.B.A., also a professor of obstetrics and gynecology and learning health sciences at U-M Medical School, added that the "costs of these behaviors are quite significant" for medical students and can include financial, educational and emotional stressors.

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"Students in their final year of medical school should really be focusing on how they can best thrive during their residency trainings," said Hammoud. "But instead, they're often bogged down by an insurmountable amount of stress associated with the application and interview processes, which are also very expensive."

These notions led the team to further examine if an early result acceptance program, usually referred to as ERAP, would improve the residency match process for OB-GYN applicants. Their findings were recently published in JAMA Network. 

"We know that the excessive amount of residency applications has a twofold effect," said Hammoud. "Not only are the students impacted, but the program directors and their staff are as well. So, we wanted to assess what key stakeholders within the application process thought about an early acceptance program to help revise this process and eliminate stress and inequities associated with the rising number of applications."

The study breakdown

Various stakeholders involved in the OB-GYN residency application process were surveyed electronically regarding their interest in an ERAP from March to April of 2021.

"We primarily focused on OB-GYN residency applicants, as well as members of the AAMC Group on Student Affairs, OB-GYN clerkship directors, residency program managers and program directors," said Morgan. "We really wanted to survey a snapshot of everyone involved in this process. When we were designing the survey itself, we incorporated feedback from OB-GYN educators, administrative leaders, medical students and residents."

To ensure that "match results" did not sway the answers of participants, the team administered the survey before Match Day.  

"The survey clearly defined ERAP as a 'binding early decision process' where students would only apply to a limited number of programs," said Morgan. "The programs could then make a portion of their residency openings available through this process, with matches announced in September, just before the main match is opened."

Using a Likert scale, each survey recipient was asked to indicate their likelihood of participating in an ERAP as a program staffer or recommending the process to one of their peers as an applicant. In addition, the respondents were asked to make a recommendation regarding their thoughts on the appropriate number of open residency positions within their program or the number of applications submitted by candidates, respectively.

"Our results were very telling, in that a majority of the stakeholder respondents said that they would participate in an ERAP, while we also observed increased numbers (in support of ERAPs) among our student respondents," said Morgan. "The survey data also showed that a proposed ERAP would include three applications per candidate and allow programs to open 25% to 50% of their positions to applicants within the first stage of the match."

Hammoud added that these findings are so significant because they will decrease the financial costs incurred by applicants, while alleviating some of their anxiety and allowing them to focus on their futures as aspiring physicians during their last year before entering their residency program.

"The removal of unnecessary applications from competitive candidates would also usher in a more holistic review process for others," she said. "And we are very excited about what the future holds."  

Paper cited: "Perspectives of Stakeholders About an Early Result Acceptance Program to Complement the Residency Match in Obstetrics and Gynecology," JAMA Network. DOI: 10.1001/jamanetworkopen.2021.24158

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