Residency selectionWho to take?
Jack Choueka, MDChairman/Program Director
Maimonides Medical Center
Brooklyn, NY
Who not to take…..
Taking the wrong resident
• Decrease morale
• Decrease work efficiency
• Patient care
• Faculty disillusionment
• Adverse effect on recruitment
• 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 = 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.
“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
My Reality
• Most residents pass their boards
• Most residents will make you proud
• Even the difficult ones find their way
Hospital Culture
• Patient mix
• Languages
• Other residency programs
• Hospital perception of residents
• Institutional opportunities
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
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
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
What if you don’t fill
• Don’t panic– Plenty of good applicants– Take your time– Review applicants– Mini interview session– Listen to references