Recommendations for changing the residency selection process based on a survey of program directors.

The authors conducted a nationwide survey of program directors participating in the 1990-91 National Resident Matching Program (NRMP) in order to solicit the directors' responses to elements of the current residency selection process and to suggested revisions. Of 680 randomly selected directors, 469 (69%) responded to the survey questionnaire, using a five-point scale, from 1, indicating strong agreement, to 5, indicating strong disagreement. The directors agreed that the senior year was distorted by the selection process, that students were pressured into making early career decisions, and that there needed to be more structure to the senior year. The directors were also in agreement that interviews, the NRMP, and the uniform notification date were working well. But deans' letters, other letters of recommendation, the Universal Application, and appointment of unmatched students were considered to be in need of improvement. The development of a centralized residency application service with the electronic transmission of data received the directors' support. The authors recommend that a task force be convened to consider changes that would improve the selection process and would reduce disruption of the students' senior year of medical education.