Cross-sectional study of dermatology residency home match incidence during the COVID-19 pandemic.

To the Editor: As per recommendations outlined by the Association of Professors of Dermatology, dermatology residency programs conducted virtual interviews for the 2020-2021 match during the COVID-19 pandemic. Leaders from the Association of Professors of Dermatology suggested that away rotations prioritize students without home programs and consider offering virtual experiences.

Prior to the pandemic, approximately 29% of dermatology residents matched at home programs and 63% matched within home regions. Furthermore, in the 2020 National Resident Matching Program survey of program directors, 92% cited “Audition elective/rotation within [the] department” as a major factor for determining whether an applicant should be interviewed, emphasizing the importance of away rotations in previous match cycles. While virtual rotations and interviews allow more flexibility, accessibility, and equity for those from low socioeconomic backgrounds, the inability to experience institutions in person may also provide less insight into the culture of each program.

This study aims to provide empirical data on how the pandemic may have influenced the incidence of matching into one's home institution during the 2021 dermatology match. We reviewed publicly available match data from 2017 to 2019 and for 2021 on program websites, social media, LinkedIn, and from email correspondence for Electronic Residency Application Service-participating dermatology residency programs in the United States. The 2020 match was excluded because there was limited availability of information on current residents exiting transitional years. Applicants were considered a “home” match if their most recent affiliation is formally associated with their matched institution.

Information was available for 56% of programs (n = 69) for the 2021 match and an average of 65 (~50%) programs for the 2017, 2018, and 2019 match cycles. Home matches increased from an average of 23.7% for the 2017-2019 match cycles to 30.9% in 2021 (P = .025) (Table I ). Analysis by logistic regression showed that programs in the 2021 virtual interview cycle had statistically significant greater odds of matching at least 1 home applicant compared with the 2017-2019 interview cycles (odds ratio, 2.3; P = .02) (Table II ). This aligns with previous analyses of COVID-19 match trends. Program size was also significant in that home matching appeared to occur more frequently with programs having more spots than the national median of 4 and less often with programs having fewer spots (P = .00001) (Table II).

Table I

Descriptive statistics summary of dermatology residency programs by year

Year	Programs (number found)	Positions per program (mean)	Positions per program (SD)	Positions per program (median)	Positions per program (IQR)	Percent of program filled with home matches (mean)	Percent of program filled with home matches (SD)	Percent of program filled with home matches (median)	Percent of program filled with home matches (IQR)	Programs matching ≥1 home applicant		Programs matching ≥2 home applicants
										Number	%	Number	%
2021	69	4.2	1.8	4.0	2.0	30.9	26.3	25.0	42.9	52	75.4	25	36.2
2019	65	4.2	1.8	4.0	2.0	23.9	25.9	20.0	40.0	39	60.0	16	24.6
2018	65	4.1	1.9	4.0	2.0	23.0	23.4	25.0	43.8	37	56.9	20	30.8
2017	65	4.0	1.9	4.0	2.5	24.1	26.0	22.2	40.0	38	58.5	21	32.3
2017-2019	195	4.1	1.9	4.0	2.0	23.7	25.0	20.0	40.0	114	58.5	57	29.2

IQR, Interquartile range.

Table II

Crude and adjusted odds ratios for a program having at least 1 home match

Variable	Crude OR (95% CI)	P (univariable)	Adjusted OR (95% CI)	P (multivariable)
Year		.01∗†		.02∗†
2017-2019	ref		ref
2021	2.2 (1.2, 4.0)	.01∗	2.3 (1.1, 4.8)	.02∗
Number of positions		.00∗†		.00001∗†
1	–	–	–	–
2	0.2 (0.07, 0.4)	<.0001∗	0.2 (0.1, 0.6)	.004∗
3	0.8 (0.4, 1.7)	.5	1 (0.4, 2.4)	.9
4	ref	–	ref	–
5	3.0 (1.1, 8.4)	.04∗	3.2 (1.1, 9.2)	.03∗
6	2.6 (0.7, 10.0)	.2	3.1 (0.8, 12.4)	.1
7	1.9 (0.6, 6.6)	.3	2.2 (0.6, 8.3)	.3
8	–	–	–	–
9	–	–	–	–
10	1.0 (0.1, 12.1)	1.0	1.2 (0.1, 16.5)	.9
Ranking		0.00∗†		.01∗†
1-25	ref		ref
26-50	0.9 (0.4, 2.0)	.8	1.3 (0.5, 3.4)	.5
51-75	0.8 (0.4 1.9)	.7	1.7 (0.6, 4.5)	.3
76-100	0.1 (0.04, 0.2)	<.0001∗	0.3 (0.1, 1.0)	.05∗
100+/No rank	0.4 (0.2, 0.9)	.03∗	1.4 (0.4, 4.6)	.6

OR, Odds ratio.

Indicates P value of statistical significance at ⍺ = .05.

Indicates variable category P values, not level specific.

If the proportion of interviews allocated to outside 2021 applicants is reflective of past years, the observed increase in home matching likely resulted from the nature of virtual rotations and interviews hindering applicants' ability to familiarize themselves with outside programs. Similarly, programs faced challenges acquainting themselves with unfamiliar applicants, resulting in applicants and institutions ranking their home counterparts higher on their rank lists. Decreased outside applicant interview offers may also explain the rise in “home matches.”

Changes in the incidence of home matching are especially significant for applicants without home dermatology departments. Recent literature demonstrates that mentorship and pipeline programs are fundamental to a successful match. Thus, students without home programs are at an inherent disadvantage in garnering academic relationships and participating in such initiatives. The paradigm shift to virtual experiences has only widened this disconnect. As institutions move toward hybrid models, these considerations are key to understanding how to best incorporate virtual interviewing while maintaining equity among applicants.

Conflicts of interest

None disclosed.