by Elizabeth Hofheinz, M.P.H., M.Ed., December 13, 2019
You’ve heard of throwing the spaghetti at the wall and seeing what sticks. These days, says Wayne Moschetti, M.D., M.S., Section Chief, Division of Adult Reconstructive Surgery and Assistant Professor at the Geisel School of Medicine at Dartmouth in Hanover, New Hampshire, for applicants it’s a bit of, “let’s throw residency applications at EVERY residency and see what sticks.”
Dr. Moschetti told OSN, “Orthopedic surgery has become so competitive that it seems many medical students are applying to every program. Our program only has four residency slots per year, but we are flooded with 600-700 applications. Obviously, this creates an untenable burden on residency programs.”
“Worse yet,” says Marcus Coe, M.D, M.S., F.A.O.A., Associate Residency Director and Assistant Professor at Dartmouth, “it creates an environment where it is very difficult for a residency applicant to distinguish themselves. In expanding the scope of their search to give them the best chance of matching, applicants have inadvertently made it harder for any program to appreciate the attributes that might make them a good fit for that program.”
“For a program of our size we will end up interviewing roughly 40-50 applicants,” said Dr. Moschetti. “It used to be that board scores made someone stand out, but these days terrific board scores are the norm. You may see some programs screening by location. For example, let’s say someone is born in California, attended college and medical school in California, and applies to a residency program in Washington, DC. If you have never been to the east coast before then the residency program might be less inclined to give you an interview despite your solid candidacy.”
“Complicating resident selection is that not all medical schools grade equally,” said Dr. Moschetti. “Our program tries to group applicants by medical school for review, so we have a better opportunity to compare apples to apples.”
“We and other programs have tried to standardize what can be standardized in applications” said Dr. Coe. “In studying our process, we realized that many measures are subjective or varied. We have gone through every application and made a combined standardized score for those factors we can 1) accurately measure between candidates, and 2) have some data that link them to future performance. It turns out there are very few of these. Board scores and third year core clerkship grades are the best objective, comparable measures we have.”
“I think a better filtering process needs to begin at the medical school level” said Dr. Moschetti. “It would be the ideal time to screen potential orthopedic surgery residents for tactile and other relevant skills. At that level, professors could test medical students on 3D spatial skills and the like. If someone has tried 20 times to hit the target with a drill and fails, well then maybe surgery might not be the best option to pursue. I’m not saying that person can’t be a good surgeon but that kind of feedback early on during training might influence an applicant’s decision. This would obviously need to be validated and studied long term to compare those who perform highly on tactile or 3D spatial relationship tests to residents who may not.”
“It seems that we need some type of standardized orthopedic assessment. One that is orthopaedic knowledge based is probably not right as it exposes differences in training. An assessment that focuses on attributes that are ideal for orthopaedic success is likely more applicable, i.e., focus on teamwork, selfless behavior, work ethic, etc. I think we could do a better job drawing from other industry like the military and the business world to identify a successful resident. Residency programs don’t always necessarily need the best ‘players’…they need the right ‘players.’ It is not necessary that every resident is a superstar; what you need is a cohesive group that works towards a common goal together.”
On the upside, this is good news for the field. It is in high demand. And, as one resident told Dr. Moschetti:
“If I got into a training program on the moon I would have gone.”
