Journal Club

Residency Selection Criteria: What Medical Students Perceive as Important. Brandenburg S, Kruzick T, Lin CT, Robinson A, Adams LJ. Med Educ Online 2005; 10:17.

Reviewed by Lindia Willies-Jacobo, University of California San Diego

Background: The criteria which program directors use to select candidates to residency programs have changed over the past several years, with more importance placed on a candidate's academic record. Recent surveys of residency program directors show that Dean's letters and other letters of recommendation are viewed as unimportant and in need of improvement. Little is known about which criteria students perceive as important in this process. A 1995 survey of graduating seniors at one institution found that students rated the interview, letters of recommendation, academic performance, and communication skills as the most important factors of their applications.

Methodology: The authors sought to determine the attitudes of medical students towards specific residency selection criteria. An anonymous web-based questionnaire was sent via electronic mail in the fall of 2002 to all medical students at 3 medical schools (University of Colorado, University of Utah, and Vanderbilt University). Students were asked to rate the importance of certain criteria in obtaining a residency position of their choice. A 4-point Likert scale was used with choices of extremely, moderately, mildly, or not important. Student responses were analyzed by year in school and by competitiveness of their chosen specialty, excluding those who were undecided.

Results: 49.2% of the students responded to the questionnaire. 16.3% of students had not yet decided on a specialty. Of those surveyed, 15.7% were interested in surgical subspecialties, 14.5% in internal medicine, 9.3% in family medicine, 9.1 in pediatrics, and 8.7% in emergency medicine. Criteria perceived as extremely important by the majority of students were the interview (80.6%), grades in courses in their chosen specialty (73.3%), letters of recommendation excluding the Dean's letter (65.3%), grades in third and fourth year clerkships (55.9%), and USMLE Step 1 score (46.7%). Of note, criteria considered mildly or not important by most students included grades in the first and second years of medical school (56.8%), academic awards (55.2%), extracurricular activities (52.6%), published research (50.9%), class rank (49.3%), and membership in AOA (46.5%). Students in the clinical years of training were more likely than the preclinical students to place importance on number of honors grades and AOA membership and were less likely to place importance on grades in fourth year electives that were not in their chosen specialty, scores on USMLE Steps 1 and 2, and the Dean's letter.

Limitations: This study was a convenience sample of only 3 medical schools, which may limit the generalizability of the findings. Additionally, no demographic information on the students is known. Characteristics such as race, gender, and age might have influenced student perceptions.

Implications: This study shows that there is significant discrepancy between what residency program directors and medical students perceive as important for residency selection. While we don't know why students' perceptions are what they are, the findings in this study suggest that there may be a problem with how students are advised, or from whom they're obtaining this advice. It would be worth ensuring that all students are aware of the importance of objective criteria in residency selection, and that this be done early in the process.

(Comment: Most residency applicants all read the same little black book. It needs an update. On another note, what does it mean when more than half of all medical students surveyed don't think grades in the basic sciences matter much? - Bill Raszka)