Residency Match Communication Too Stressful, Needs Reform

Ryan Syrek, MA

Disclosures

October 10, 2018

A new study in the Journal of Graduate Medical Education aims to further expose inappropriate and stressful communication associated with the residency match process. As one of the study's authors, Rahul D. Tendulkar, MD, program director of the Cleveland Clinic's radiation oncology residency program, explained to Medscape, "The reason we wanted to study this is that there are a lot of unwritten rules about the process and a lot of habits that have persisted over decades with regard to how applicants and programs communicate with each other."

The study revealed that a large number of residency candidates experience distress that involves laborious postinterview communication. These candidates also reported a significant amount of noncompliance with National Resident Matching Program (NRMP) guidance regarding questions that should not be asked during the residency interview process. As Tendulkar elaborated, "Frankly, a lot of illegal questions are asked... A lot of interviewers at programs are not properly educated about what is legal or what is illegal."

In an accompanying commentary, Nicole M. Deiorio and Benjamin N. Schneider suggested that the NRMP "should play an expanded role in providing clear and binding guidance" in these matters. As students already face significant stress in attempting to meet the expectations of potential residency programs, this latest study is presented as further evidence that stricter guidelines during match communications may provide a potential source of relief.

Off-Limit Questions and Postinterview Anxiety

In the study, a 31-question survey was provided to residency candidates applying to nine residency programs at a single academic institution. Of the 2079 respondents, 72% were asked at least once about interviews with other programs, 38% were asked about their marital status, and 17% were asked about children. Women were more frequently asked about family planning than were men (22% vs 14%).

In terms of exchanges after the official interview, more than 90% of applicants engaged in some form of communication, ranging from thank-you notes to emails. Although most often initiated by applicants (77%), 22% of respondents stated that they only sent thank-you notes out of fear.

The majority (70%) of applicants explicitly told their top program that they had given it a high ranking. However, 70% reported stress associated with this particular communication, and 20% later changed their rankings based on postinterview engagement. "The whole purpose of the match is to eliminate some of the untoward dealmaking that can occur and to ideally promote more of a fair and meritocratic process to give both applicants and programs the best fit for one another," Tendulkar pointed out. "Unfortunately, some people try to game the system by trying to give false assurances."

In terms of postinterview communication, more than 70% of respondents indicated that they wished such communication were explicitly discouraged, and more than half said they wanted programs to bar candidates from notifying them of a high rank in order to avoid match manipulation. Only 20% of the programs outright discouraged postinterview communication. This was most common among radiation oncology, internal medicine, and dermatology.

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