How Should Unmatched Otolaryngology Applicants Proceed? Josianna Schwan BS, Mona Abaza MD MS, Cristina Cabrera-Muffly MD FACS University of Colorado, Aurora, Colorado ABSTRACT INTRODUCTION Objective To determine the attitudes of otolaryngology residency program directors and chairpersons towards unmatched residency applicants, including whether a surgical internship or research year is preferred in considering repeat applicants. Design Cross-sectional survey. Subjects and Methods Approval was obtained from the Colorado Multiple Institution Review Board. A 12-question web-based survey was sent to Otolaryngology residency program directors and chairpersons three times over a six week period. Responses were anonymous with no identifying characteristics were collected from respondents. Results 45% of those contacted responded to the survey. The most commonly recommended course of action for an unmatched applicant was completion of a PGY-1 Surgery Year (43%) or a year of research (31%). Program Directors were more likely than Chairpersons to recommend a year of research (p-value 0.014). 97% of the respondents felt it was important or essential to obtain new letters of recommendation. Respondents ranked poor interview skills as the most common reason for applicants remaining unmatched (29%). Conclusion Otolaryngology residency match is even more competitive for previously unmatched applicants. Unmatched applicants should be advised to proceed with either a research year or PGY-1 General Surgery year. Before applying again, applicants should obtain new letters of recommendation, and the importance of improving poor interviewing skills should be emphasized by advisors. Obtaining a residency position in Otolaryngology is very competitive and results in a significant number of unmatched applicants annually.1 A majority of previously unmatched applicants fail to match during their second attempt.2 There is no consensus-based guidance as to how repeat applicants can best optimize their application for the following year. Objectives: To determine whether programs are receptive to interviewing and accepting repeat applicants To determine whether programs view a preliminary surgical internship versus a year of research as preferable To determine how program leaders perceive the importance of various components of the application DISCUSSION Completion of a PGY-1 General Surgery year was more highly recommended than a research year (43% vs. 31%), but respondents indicated that they were more likely to interview a repeat applicant doing a research year at their institution versus a preliminary surgery year (81% vs. 54%). Most of the respondents recommending a PGY-1 General Surgery year were chairpersons (68%), while most of the respondents recommending a research year were program directors (60%, p=0.014). The top three reasons respondents felt a repeat applicant did not match were poor interview (29%), low USMLE Step 1 scores (23%), and non-allopathic medical pathway. New letters of recommendation were felt to be important for a repeat application. METHODS When comparing only respondents who advised a PGY-1 General Surgery year or research year as their top recommendation, there was a significant difference (p-value = 0.014) between Chairs (more likely to recommend PGY-1 year) and Program Directors (more likely to recommend research). Respondents were asked to rank the most important reason applicants do not match. Choices included: poor interview skills, low USMLE scores, non-allopathic graduate, lack of research, poor clerkship grades, poor letters of recommendation, lack of volunteer experience, or low class rank/non-AOA status. See below for responses. Institutional review board approval was obtained from the Colorado Multiple Institution Review Board. Between March 4 and April 6, 2014, an anonymous 12 question web-based survey was administered to program directors and chairpersons of the 100 non-military based Otolaryngology residency programs accredited by the ACGME. Statistical analysis was performed using JMP 11.0 software. Univariate analysis was performed with a p-value of 0.05 determined as significant. CONCLUSIONS Unmatched applicants who plan to apply again for an Otolaryngology position should be counseled to do either a PGY-1 General Surgery year or a year of research. Advisors should emphasize the improvement of modifiable factors of the application, including new letters of recommendation and interview skills. RESULTS REFERENCES CONTACT 1 National Residency Matching Program, Results and Data, 2014. National Resident Matching Program, Washington, DC 2014. 2 Calhoun KH, Hokanson JA, Bailey BJ. Predictors of residency performance: a follow-up study. Otolaryngol Head Neck Surg. 1997;116(6):647-651. Cristina Cabrera-Muffly, M.D. University of Colorado Department of Otolaryngology cristina.cabrera-muffly@ucdenver.edu 97% of respondents felt it was essential or somewhat important to obtain new letters of recommendation prior to re-application.