The residency-application process varies widely among specialties, with programs occasionally using different amounts or types of program signals, alternative interview formats and more. For residency program directors reviewing applications and medical students wanting to maximize their chances, spelling out the specialty-specific standards can clear up confusion and smooth the way forward.
With that in mind, the AMA has joined with the Organization of Program Directors Association and the Association of American Medical Colleges (AAMC) in launching the “Program Directors Association Guide for Residency Applicants.”
The resource—launched ahead of when residency applicants can start submitting applications to residency programs in early September—is a series of documents that include specialty-specific guidance to boost transparency and help program directors and medical students navigate the process.
“As a group, medical students apply to many different specialties and, I would say, over the last five to 10 years, the process has become more complex,” said John Andrews, MD, the AMA’s vice president of graduate medical education innovations. “It’s all in the interest of serving program directors and the applicants, but the result is that individual specialties are creating different standards for what they expect in the application process.”
The new guides provide clarity on the application process in 28 physician specialties, as well as the transitional year residency application process. There are two guides for the specialty of medical genetics and genomics—one for categorical and one for combined residencies.
Topics in the guides, depending on the specialty, can include away rotations, use of United States Medical Licensing Examination (USMLE) or Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) scores, open houses or second looks, letters of recommendation, specialty-specific questions on residency applications and more.
“Program directors have adapted in their local environments in constructive ways, but not always in ways that are consistent across the specialty,” Dr. Andrews said. “And this is now an effort to say: OK, we've been doing this for a while now. Let's all agree to do it in this particular fashion so it's easier for all of us.”
Tackling signaling’ s complexity
Some of the complexity has arisen as a way of coping with the high volume of residency applications in certain specialties.
“The essential challenge for residency program directors, particularly in highly competitive specialties, is that they receive far more applications than they can, realistically, holistically review,” Dr. Andrews said. “So, they have to have some way of winnowing that pool to a number of applications that they'll read in their entirety and that hopefully gives them a high yield in terms of the people who come to their program. Signaling helps with that.”
With the introduction in recent years of signaling, intended to let residency applicants show strong interest in a residency program and help program directors find applicants most interested in their programs—combined with changes to other aspects of the process—the landscape can now vary greatly from specialty to specialty.
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“The things that are making it more complex have all been designed to make the process better,” Dr. Andrews said, while acknowledging that “because the changes are somewhat heterogeneous by specialty, the environment has become a bit more confused.”
The guides, therefore, explicitly lay out the amount and types—when relevant—of program signals and say whether the particular specialty permits signaling of home institutions or away rotation sites. It can help medical students to understand the different needs and requirements related to signals so they can target theirs appropriately.
For example, in specialties with just a handful of signals, residency program directors will understand that a signal indicates strong interest. But in specialties with 30 signals, for example, if an applicant doesn’t signal, they’re unlikely to receive an interview invitation at all, creating a “soft cap” of sorts.
“That's been a difficult thing to demystify for applicants—to help them understand that based upon the way the signals are used, the information it conveys to a program may be very different,” Dr. Andrews said.
Move to common methods
Standardizing the residency-application process within a specialty brings a host of benefits, Dr. Andrews noted.
“Some specialties have achieved real consensus around these things. We've been working closely, for example, with the obstetrics and gynecology community, and they've issued standards across their specialty for when interview invitations are issued for when applicants can expect to know that their application is either progressing or not progressing,” he said.
“That uniformity across the specialty has really helped the program directors and, importantly, has really helped the applicants,” Dr. Andrews added. “We'd like to see more of that in other specialties, and I think we're moving in that direction.”
The guides are a furthering of that standardization in the process, he said.
“It just makes it so that a program director in Kansas and a program director in New York City are conducting their application and selection process in a similar manner and, again, that helps everybody.”
