Residency selection Who to take? Who not to take….. Jack Choueka, MD Chairman/Program Director Maimonides Medical Center Brooklyn, NY

Disclosures Reviewer – JHS Speaker – Xiaflex Instructor - Synthes

Easier to get rid of your spouse than a resident

7% of all matched residents require substantial remediation or dismissal from residency training

Taking the wrong resident Decrease morale Decrease work efficiency Patient care Faculty disillusionment Adverse effect on recruitment

Who would you take??

Local 245 AOA Good research No rotation OK Interview Great letters Regional 230 Not AOA Some research Great rotation Great Interview Bad Eval in OB/GYN Distant 275 No research Good Interview Bland letters

ERAS Education History Work/Volunteer/Research Experience USMLE Scores Personal Statement Letters of Recommendation (LOR) Deans Letter Transcript AOA, Honors, Awards Other Factors: felonies, couples match, military obligation, citizenship/Visa requirements

What we do Set filters (med school, board scores) Assign reviewers who actually will read the applications Each application reviewed by at least 2 reviewers Offer interviews when consensus occurs

AOA Steering Committee Cognitive skills Motor Ability Affective domain

AOA Steering Committee Cognitive skills = Pass boards Motor Ability = Can operate Affective domain = Won’t torture you

Evidence Based??

USLME Poor correlation with clinical skill acquisition Correlates only when outcome is another multiple choice test McGaghie et al. “Are the USMLE Step 1 and 2 Scores Valid Measures of Postgraduate Medical Residency Selection Decisions?” Acad Med. 2011; 86:48-52.

Professionalism Determine whether standardized admissions data in ERAS were associated with assessments of professionalism Comparative statements in LORs (p=.002). Cullen, et al. “Selection Criteria for IM Residency Applicants and Professionalism Ratings During Internship”. Mayo Clin Proc. 2011; 86(3):197-202.

Orthopaedic Specific Research

No faculty consensus about ranking of residents upon graduation “Resident Selection: how are we doing and why?” Thordarson, et al. Clinical Orthopedics and Related Research 2007 Fair/poor correlations noted between residents’ initial and graduation rankings No faculty consensus about ranking of residents upon graduation

Dirschl et al. “Resident selection and predictors of performance: can we be evidence based?” Clinical Orthopedics and Related Research 2006 Objective: To determine if an academic score, using objective elements only, will discriminate among applicants and correlate with resident outcomes Conclusion: Calculating academic score makes application screening process more objective does not appear to correlate with outcomes of the training program

Affective Domain Rated as high importance for PD’s Correlates with number of medical school honors (Dirschl 2002)

Predictors of Residency Success Charitable involvement Varsity sports – selection to chief resident (Spitzer et al HJD 2009)

Summary No real consensus on good predictors Outcome measures vary among studies Faculty evaluations too inconsistent Program specific

Milestones may provide more universal outcome measures

My Reality Most residents pass their boards Most residents will make you proud Even the difficult ones find their way

….But I need to get through the day

Program Fit Hospital’s culture Know your faculty Resident environment

Hospital Culture Patient mix Languages Other residency programs Hospital perception of residents Institutional opportunities

Faculty Clinical vs. Academic Teaching style Specific mentor

Your Residents Which ones thrive Hierarchy Diversity

Our culture Highly diverse patients pop. 73 languages Extreme VIPism Large residencies in other specialties with large numbers of IMG’s Residents Included at many administrative levels Small busy program = cross coverage

Traits we look for Leadership Independent Teaching ability Team players Inspirational Ethical Potential faculty

Past experience determines future performance Know the traits you want Ask for specifics Let them do the talking

80% of US applicants Match They pick you more than you pick them

The match curve Program Top Middle Bottom Middle Bottom Top Applicant

The match curve Program Top Middle Bottom Middle Bottom Top Applicant

The match curve Program Top Middle Bottom Middle Bottom Top Applicant

The match curve Program Top Middle Bottom Middle Bottom Top Applicant

Things that tip your position on the match curve Program size Academic affiliations Location Institutional viability High turnover of faculty Unhappy residents Disorganized selection process

Improve your position Respect the candidates Good communication Prepared for interviews Engaged faculty and residents Lunch Interview reception Website/social media

Making the rank list

Develop ranking system Be consistent Rankers Criteria Include residents in interview

The Shoe-in Tend to move down the list If you want them take them

The overqualified candidate Would you take them without the resume Do they have passion for the program Same qualities that make them overqualified probably makes them adapt

Board Scores Decide on minimum requirement and don’t look back

Call references

Most important rank Last one on the list Would rather have that person than nobody

What if you don’t fill Don’t panic Plenty of good applicants Take your time Review applicants Mini interview session Listen to references

Thank You