Guiding Medical Students Through the Match: Perspectives From Recent Graduates
* University of Connecticut School of Medicine, Hartford, Connecticut
University of Maryland School of Medicine, Baltimore, Maryland
University at Buffalo School of Medicine, Buffalo, New York
|| Mayo Medical School, Rochester, Minnesota
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ABSTRACT |
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 TOP ABSTRACT METHODSRESULTSDISCUSSIONREFERENCES |
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Objective. Little has been written about the counseling of medical students as they go through the process of selecting and ranking residency programs for the National Resident Matching Program. The Association of Pediatric Program Directors (APPD) and the Council on Medical Student Education in Pediatrics jointly sought to evaluate the current status of advice and counseling for students going through the Match, and to elicit suggestions for improvement.
Methods. Surveys evaluating satisfaction with aspects of and advice received regarding the Match were sent to each of the 199 Accreditation Council for Graduate Medical Education accredited member programs of the APPD with a request that they be distributed to all first-year pediatric residents during the orientation process for the 2001–2002 academic year. Surveys were both voluntary and anonymous. Results were compiled by the administration of the APPD.
Results. We received responses from 42% of all US pediatric categorical or combined residents entering pediatric residency in July of 2001. Respondents included at least 1 representative from every US medical school. Ninety-seven percent of respondents were either very satisfied (88%) or somewhat satisfied (9%) with where they matched, whereas 82% were either very (42%) or somewhat (40%) satisfied with the advice they received regarding the match. The Fellowship and Residency Interactive Database, the faculty advisor, and resident-to-student counseling were the top 3 resources identified by the respondents. Of 12 resources listed in the survey, only the Green Book was rated as unhelpful. Four areas for improvement regarding the advising process were identified: timing, standardization, and quantity of advice and accuracy of online information resources, with specific suggestions given for each.
Conclusions. Overall, recent medical school graduates are quite satisfied with both where they matched in pediatrics and the process that got them there. However, several areas for improvement in the advising/counseling system were identified. Potential approaches to these concerns or resources to develop approaches to them were identified.
Key Words: Medical education • counseling • National Resident Matching Program • the Match
Abbreviations: COMSEP, Council on Medical Student Education in Pediatrics • APPD, Association of Pediatric Program Directors • NRMP, National Resident Matching Program • FREIDA, Fellowship and Residency Interactive Database
Terry Stein, a medical student writing on counseling in medical school,1 quotes an observation from Abraham Flexner’s 1925 treatise A Medical Education: A Comparative Study: "The use of sound methods ought to be enough; it ought to be left to the mature university student and his family to profit by them or not."2 For most of the remaining 20th century, the notion that medical students should "profit or not" from their medical education without the additional assistance of advisors or mentors persisted. Not until the 1980s to 1990s did the concept of career counseling in medicine even emerge in the literature.
In 1987, K. C. Kalman devoted an editorial in Medical Teacher to defining the concepts of career counseling and guidance.3 Although he agreed with Flexner that the majority of students could perform on the merits of the sound methods behind their education, he identified a small group who require career guidance from an early stage, and an even smaller group who require career counseling from a trained professional.
Since that time, more educators have focused on the need for an "objective, formalized" approach to career advising and counseling of medical students.4 A few authors have described school-specific programs and their successes or failures.5,6 Although most, if not all, US medical schools provide a myriad of formal and informal counseling methods currently, little has been written on the efficacy of any single program or on the satisfaction of the participants with the process as a whole. A review of the literature, in fact, revealed no account of methods or their successes and/or failures, for counseling medical students through the match in pediatrics.
The leaders of the Council on Medical Student Education in Pediatrics (COMSEP), which is the organization of pediatric clerkship directors at North American allopathic medical schools, and the Association of Pediatric (residency) Program Directors (APPD), sought to evaluate the effectiveness of both the match process overall and current resources available for helping students who are interested in a career in pediatrics through the match. Therefore, we surveyed all new pediatric categorical and combined interns during their orientation to residency, while the experience of the match was still fresh and the outcome determined.
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METHODS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
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Surveys were sent to each of the 199 Accreditation Council for Graduate Medical Education accredited US pediatric residency program directors who belong to the APPD, with a request that they be distributed to all first-year pediatric residents during the orientation process for the 2001–2002 academic year. This sample represents 96% of the 208 Residency Review Committee accredited pediatric residency programs. The surveys contained a total of 13 questions. The first 6 questions requested demographic data regarding the match, such as number of programs applied to, number of interviews, number of programs ranked, and the rank of the ultimate program at which the respondent matched. Two questions examined satisfaction with the match process itself, as well as its components. The remainder of the survey focused on the respondents’ satisfaction with and their rating the utility of various aspects and methods of counseling they received throughout the match process. Surveys were both anonymous and voluntary. The surveys were collected and returned to the APPD.
Analysis
Means were calculated for numerical discrete data. Likert scale responses are presented as percentage of respondents with each response. Qualitative data were categorized by one of the authors (R.E.), and are presented as rank order, percent of respondents, and/or frequency of categorical response.
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RESULTS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
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A total of 1064 of 2507 surveys were returned (response rate of 42%). Each of the 141 medical schools of the United States had at least 1 respondent. In addition, 84 foreign medical schools were represented among the respondents. Ninety-seven or nearly 70% of US schools had at least 3 respondents. Twenty-eight or nearly 20% of US medical schools had at least 10 respondents. These medical schools were located in each of the American Academy of Pediatrics 10 districts. Ninety-three percent of respondents matched through the National Resident Matching Program (NRMP).
Respondents applied to a mean of 18 programs. They were invited to interview at a mean of 13, and attended interviews at a mean of 9 programs (see Table 1). Of those who went through the NRMP, 68.3% matched at their first choice program, 15.4% at their second choice program, 7.8% at their third choice program, 3.4% at their fourth choice program, 2.8% at their fifth choice program, and 2.3% at a program below their fifth rank (see Fig 1).
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Sixty percent of students had performed an "audition" clerkship at their top choice program. Ninety-two percent of those performing an audition clerkship reported it to be helpful in the matching process. For those whom it helped,
45% reported it allowed them to get a better idea of the individual program strengths and weaknesses, and 25% of these were helped by negative observations steering them away from the program. Another 45% of students reported that the clerkship helped them get to know the residents and faculty of the program better and vice versa. A small but noteworthy number of students found the clerkship helpful because they perceived themselves as performing better in person than "on paper." Regarding satisfaction with where they matched, 88% of students were "very satisfied," 9% "somewhat satisfied," and only 3% either "somewhat dissatisfied," or "very dissatisfied." Greater than 90% of those dissatisfied with where they matched did so at or below their fourth rank. When asked about satisfaction with the overall advice/counseling received from their medical school, 82% reported being very (42%) or somewhat (40%) satisfied, 13% were somewhat dissatisfied, and 5% were very dissatisfied. Of those students who were somewhat or very dissatisfied with their school’s advice/counseling, nearly half matched at or below their third choice.
The vast majority of students were satisfied with the following individual components of the match: 1) accessibility of information on Pediatric training programs (94% somewhat or very satisfied); 2) use of the Electronic Residency Application Service (96%); and 3) interviewing process (96%). Students were also somewhat or very satisfied with the advice they received on the following aspects of the match: 1) obtaining letters of recommendation (91%); 2) number of programs to apply to (88%); 3) types of programs to apply to (88%); 4) personal statement (86%); 5) scheduling the senior year (80%); and 6) "away" or "audition" electives (75%).
Of the resources available to aid students in the match, the Fellowship and Residency Interactive Database7 ([FREIDA], an online reference provided by the American Medical Association containing listings of all residency and fellowship training programs in the United States), student-to-student counseling, the advice obtained from the residency training program director at the respondent’s medical school, resident-to-student counseling, the faculty advisor, the Dean of Student Affairs, and the Pediatric Department Chair were all rated as helpful. Only the Green Book8 was rated overall as unhelpful. When asked what 3 resources should be available to all students going through the match, the top 3 responses were faculty advisor, FREIDA, and resident-to-student counseling. These and other resources mentioned by the students are presented in rank order with the total number of responses in Table 2.
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In addition to these resources, several respondents suggested the use of 1 of 2 publications: Strolling Through the Match,9 a publication of the American Academy of Family Physicians, and Iserson’s Getting Into a Residency Program: A Guide for Medical Students.10 The latter provides a detailed list of activities students should perform from their first year of medical school to prepare for choosing a specialty, through the fourth year of medical school and participation in ERAS and the Match. A sixth edition should be available in January of 2003.
Finally, we asked students what changes they would make to improve the counseling and guidance of medical students in the fourth year. Four major areas of concern emerged: 1) timing of the advice, 2) quality of the advice, 3) quantity of the advice, and 4) quality of the information available online. Specifically with regard to the timing of the advice, students wanted the advising/counseling process to begin early in the third year. In addition, a substantial number of respondents recommended providing an overview of the match process with a timeline to all third-year medical students.
Issues on the quality of advice offered predominantly addressed the importance of providing faculty development programs to "standardize" the advice provided by faculty in general, and by Pediatric Chairs in particular. Regarding the quantity of advice, nearly 100% of respondents would implement additional forums, either with other students, residents, faculty, or a combination thereof. Several students suggested in particular a student-run forum immediately following the match, in which recently matched students counsel third-year students about to embark on the process.
Finally, the respondents noted some issues with the data available online. Several reported errors in information obtainable through FREIDA, predominantly as a result of a lack of updating of information. Many respondents also described a wide range of quality in information available online for each of the US and Canadian Pediatric Residency Training Programs.
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DISCUSSION |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
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This survey represents collaboration between 2 organizations responsible for pediatric education along the continuum. Although both COMSEP and the APPD usually focus on curriculum and evaluation, the organizations’ leaders also recognized the importance of creating a foundation in medical school that facilitates the transition to residency. The knowledge, skills, and attitudes established during medical school, and the curriculum provided during residency can be optimized by an informed and successful application and match process through the NRMP.
The overwhelming majority of new pediatric interns who responded to our survey were satisfied with both the program to which they matched and the advice and counseling they received along the way. Despite a lack of a comprehensive and coordinated approach to the counseling of fourth-year medical students regarding the matching process in pediatrics, medical educators seem to be doing a reasonable job according to those with the most recent experience.
These survey results did identify, however, areas for improvement in counseling third and fourth year medical students through this long and often arduous process. These areas, as well as potential solutions or resources for solutions, are outlined below:
- Timing of advice. The major concern regarding timing of advice focused on the desire for a "timeline" of sentinel events in the process. Respondents suggested that such a timeline be provided sometime in the early part of the third year to allow adequate time for anticipation of and preparation for each step. The American Academy of Family Practice Website has provided just such a timeline to applicants in their specialty.11 The American Academy of Pediatrics had provided a similar online resource, "Selecting a Pediatric Residency: An Employment Guide." This publication, however, was taken offline within the past 2 years. The American Academy of Pediatrics resident section could serve potentially as a resource for updating and replacing this guide, perhaps after examining the timeline provided by the American Academy of Family Practice and editing as necessary to tailor it to the needs of pediatric applicants. The pediatric-specific timeline could then be placed on the Academy’s Website (http://www.aap.org/), the APPD Website (http://www.appd.org/), and/or the COMSEP Website (http://www.comsep.org/).
- Quality of the advice. Lack of any standards for advisors formed the basis for this concern. The solution could lie with the APPD and COMSEP to: 1) develop national guidelines for essential knowledge and skills necessary for counseling students on the match process, and 2) develop a program of faculty development for guideline dissemination. Specific areas of concern to the respondents included: 1) providing a "realistic" match of the student’s performance record with programs to which they were applying; 2) providing guidelines for obtaining letters of recommendation, 3) writing the personal statement, 4) guidance for the interview, including holding "mock" interviews, and 5) setting up away or "audition" electives.
- Quantity of advice. Respondents overwhelmingly found forums helpful that engaged faculty, residents, and students who had been through the match in panel discussions on the details of the process. These group sessions provided advice from choosing a specialty to writing a personal statement to what to wear on an interview. Several forums spread throughout the process and focused on a timely topic could address the needs of the majority of students. Examples suggested by students included a session in the spring of the third year on obtaining letters of recommendation, a summer session on writing the personal statement, and a fall session on the ideal interview, with the opportunity for "mock" interviews or role playing. The APPD and COMSEP may be able to facilitate this process by offering programs and templates to their memberships.
- Quality of the information available online. Some respondents raised concerns regarding the accuracy of data on FREIDA, primarily as a result of data that was outdated. This issue could be addressed by the American Medical Association. However, the issue needs to be taken in the context of the overall satisfaction with FREIDA expressed by the respondents. In fact, FREIDA was ranked first among resources that should be available to all students going through the match. Respondents also raised concerns about the lack of uniformity of the information provided on individual program Websites. Once again, a partnership could be established between the APPD and COMSEP to provide Web-based key program information to meet student needs. Once this is established, a template for a frequently asked questions page could be created and incorporated by programs into their Websites.
Caution must always be exercised in the evaluation of survey information. A low response rate (42%) creates concern regarding "selection bias"; that is, the 42% may represent a disproportionate number of students who were either more or less satisfied with the match and its various components than the total population of new pediatric interns. The fact that all US and Canadian medical schools were represented among the respondents, however, suggests a more general population sample. In addition, schools with >10 respondents were located in each of the 10 American Academy of Pediatrics districts.
Even considering the above caution, those who provide advice and guidance to medical students during the match process can take comfort in knowing that the majority of students professed satisfaction with the advice they received. The respondents did identify, however, several areas for improvement; we hope that some of the above solutions offer a start for those actively involved in and dedicated to the betterment of the educational system for all students choosing pediatrics as their career.
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ACKNOWLEDGMENTS |
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Special gratitude is offered to Laura Degnon, Executive Director of the APPD, for her support of this survey and the data collection.
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FOOTNOTES |
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Received for publication Aug 28, 2002; Accepted Jan 6, 2003.
Reprint requests to (R.E.) Connecticut Children’s Medical Center; 282 Washington St, Hartford, CT 06106. E-mail: renglan{at}ccmckids.org
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- Fellowship and Residency Interactive Database. Available at: www.ama-assn.org/ama/pub/category/2997.html. Accessed July 2002
- Graduate Medical Education Directory. American Academy of Family Practice; 2002
- Strolling Through the Match: A Medical Students Guide. Available at: http://www.aafp.org/student/match/. Accessed July 2002
- Iserson KV. Iserson’s Getting into a Residency: A Guide for Medical Students. 5th ed. Tucson, AZ: Galen Press; 2000:594
PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics
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