Residency Placement Fever: Is It Time for a Reevaluation?

The transition from undergraduate medical education to graduate medical education (GME) involves a process rooted in the final year of medical school. Students file applications through the Electronic Residency Application Service platform, interview with residency training (i.e., GME) programs from which they have received invitations, and generate a rank-ordered preference list. The National Resident Matching Program reconciles applicant and program rank lists with an eye towards matching students and GME programs. This process has effectively served generations of graduating medical students. However, the past several decades have seen an intensification of the residency placement process that is exemplified by an inexorable increase in the number of applications filed and number of interviews accepted and attended by each student. The authors contend that this trend has untoward effects on both applicants and departments that are home to GME programs. Relevant information in the peer-reviewed literature on the consequences and benefits of the intensification of the residency placement process is scant. The authors address factors that may contribute to the intensity of the residency placement process and the relative paucity of data. They propose approaches to reverse current trends, and conclude that any reevaluation of the process will have to include the generation of outcome data to afford medical educators the opportunity to explore changes in an evidence-based manner.