Residency selectionWho to take?

Jack Choueka, MDChairman/Program Director

Maimonides Medical Center

Brooklyn, NY

Who not to take…..

Disclosures

• Reviewer – JHS

• Speaker – Xiaflex

• Instructor - Synthes

Easier to get rid of your spouse than a resident

7% OF ALL MATCHED RESIDENTS

REQUIRE SUBSTANTIAL REMEDIATION OR DISMISSAL FROM RESIDENCY TRAINING

Taking the wrong resident

• Decrease morale

• Decrease work efficiency

• Patient care

• Faculty disillusionment

• Adverse effect on recruitment

Who would you take??

• Local

• 245

• AOA

• Good research

• No rotation

• OK Interview

• Great letters

• Regional

• 230

• Not AOA

• Some research

• Great rotation

• Great Interview

• Bad Eval in OB/GYN

• Distant

• 275

• AOA

• No research

• No rotation

• Good Interview

• Bland letters

ERAS– Education History– Work/Volunteer/Research Experience– USMLE Scores– Personal Statement– Letters of Recommendation (LOR)– Deans Letter– Transcript– AOA, Honors, Awards– Other Factors: felonies, couples match, military

obligation, citizenship/Visa requirements

What we do

• Set filters (med school, board scores)

• Assign reviewers who actually will read the applications

• Each application reviewed by at least 2 reviewers

• Offer interviews when consensus occurs

AOA Steering Committee

• Cognitive skills

• Motor Ability

• Affective domain

AOA Steering Committee

• Cognitive skills = Pass boards

• Motor Ability = Can operate

• Affective domain = Won’t torture you

Evidence Based??

USLME

– Poor correlation with clinical skill acquisition

– Correlates only when outcome is another multiple choice test

– McGaghie et al. “Are the USMLE Step 1 and 2 Scores Valid Measures of Postgraduate Medical Residency Selection Decisions?” Acad Med. 2011; 86:48-52.

Professionalism

• Determine whether standardized admissions data in ERAS were associated with assessments of professionalism

• Comparative statements in LORs (p=.002).

• Cullen, et al. “Selection Criteria for IM Residency Applicants and Professionalism Ratings During Internship”. Mayo Clin Proc. 2011; 86(3):197-202.

Orthopaedic Specific Research

“Resident Selection: how are we doing and why?” Thordarson, et al. Clinical Orthopedics and Related Research 2007

• Fair/poor correlations noted between residents’ initial and graduation rankings

• No faculty consensus about ranking of residents upon graduation

Dirschl et al. “Resident selection and predictors of performance: can we be evidence

based?” Clinical Orthopedics and Related Research 2006

• Objective: To determine if an academic score, using objective elements only, will discriminate among applicants and correlate with resident outcomes

• Conclusion: Calculating academic score makes application screening process more objective does not appear to correlate with outcomes of the training program

Affective Domain

• Rated as high importance for PD’s

• Correlates with number of medical school honors (Dirschl 2002)

Predictors of Residency Success

• Charitable involvement

• Varsity sports – selection to chief resident– (Spitzer et al HJD 2009)

Summary

• No real consensus on good predictors

• Outcome measures vary among studies

• Faculty evaluations too inconsistent

• Program specific

Milestones may provide more universal outcome measures

My Reality

• Most residents pass their boards

• Most residents will make you proud

• Even the difficult ones find their way

….But I need to get through the day

Program Fit

• Hospital’s culture

• Know your faculty

• Resident environment

Hospital Culture

• Patient mix

• Languages

• Other residency programs

• Hospital perception of residents

• Institutional opportunities

Faculty

• Clinical vs. Academic

• Teaching style

• Specific mentor

Your Residents

• Which ones thrive

• Hierarchy

• Diversity

Our culture

• Highly diverse patients pop.• 73 languages• Extreme VIPism • Large residencies in other specialties with large

numbers of IMG’s• Residents Included at many administrative levels• Small busy program = cross coverage

Traits we look for

• Leadership

• Independent

• Teaching ability

• Team players

• Inspirational

• Ethical

• Potential faculty

Past experience determines future performance

• Know the traits you want

• Ask for specifics

• Let them do the talking

80% of US applicants Match

• They pick you more than you pick them

The match curve

Program

Applicant Middle BottomTop

Top Middle Bottom

The match curve

Program

Applicant Middle BottomTop

Top Middle Bottom

The match curve

Program

Applicant Middle BottomTop

Top Middle Bottom

The match curve

Program

Applicant Middle BottomTop

Top Middle Bottom

Things that tip your position on the match curve

• Program size

• Academic affiliations

• Location

• Institutional viability

• High turnover of faculty

• Unhappy residents

• Disorganized selection process

Improve your position

• Respect the candidates

• Good communication

• Prepared for interviews

• Engaged faculty and residents

• Lunch

• Interview reception

• Website/social media

MAKING THE RANK LIST

Develop ranking system

• Be consistent

– Rankers– Criteria– Include residents in interview

The Shoe-in

• Tend to move down the list

• If you want them take them

The overqualified candidate

• Would you take them without the resume

• Do they have passion for the program

• Same qualities that make them overqualified probably makes them adapt

Board Scores

• Decide on minimum requirement and don’t look back

Call references

Most important rank

• Last one on the list– Would rather have that person than

nobody

What if you don’t fill

• Don’t panic– Plenty of good applicants– Take your time– Review applicants– Mini interview session– Listen to references

Thank You