The Matching Program From a First-Year Resident's Viewpoint Lawrence

Koplin,

MD

matching The residency occurred

program,

which in March 1976, was for me and for many of my medical school compatriots a very traumatic experience, one that will be remembered for many years. The process begins a full year before the actual selection of residents is made. During that year, it occupies a considerable amount of the student's time, costs a significant amount of money, and produces an extensive amount of emotional anguish for those involved. PROBLEMS WITH MATCHING PROGRAM What is really taking place, and why is it such a harrowing experience? From my viewpoint, the matching program is in many ways, a high-level sophisticated version of consumer

America. The process involves

ketplace of

a mar-

highly qualified medical school graduates who are competing for a limited number of quality positions in residency programs. On one hand, we have the residency training programs that essentially rely on the surgical resident for primary patient care. These programs have a certain number of posi¬ very

tions that must be filled every year. Each program, of course, wishes to fill these with the best, brightest, and most hardworking physicians availfor publication Nov 29, 1977. From the Department of Surgery (Head and Neck Surgery), UCLA School of Medicine, Los

Accepted

Angeles.

Read before the 11th annual meeting of the Society of University Otolaryngologists, San Francisco, Nov 11, 1976. Reprint requests to Department of Surgery (Head and Neck Surgery), UCLA School of Medicine, Los Angeles, CA 90024 (Dr Koplin).

able. On the other hand, we have the residency applicants who at the end of the third year of medical school begin their long journeys, crossing the coun¬ try in search of a residency program. The process eventually culminates in the residency match the following March. The goal of this complicated procedure is to theoretically enable the applicants to match with the best training program that suits their needs. Whereas the training pro¬ grams go through the same repetitive process selecting residents every year, the poor harried medical student is faced with a unique set of far-reach¬ ing decisions. First, each student has to decide which field of medicine he/ she wants to enter. This is not an easy decision because at this stage of learn¬ ing all the major areas of medicine, surgery, and pediatrics may be very appealing. Second, decision must be made as to what type of specialty residency the student desires. The next decision is what type of intern¬ ship will most effectively lead into that coveted specialty residency. It is this stressful atmosphere, in which programs are competing among them¬ selves for the best residents, and students are grappling for the top programs, which creates a miserable situation that I think is counterpro¬ ductive to all parties concerned. The following suggestions on how to improve this unsatisfactory situa¬ tion are from the point of view of a first-year resident who has just been through the experience. The medical student's continual challenge to make himself/herself "desirable" is a task at which he/she has already had considerable experience. It began by

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being accepted to a quality under¬ graduate school. The mere fact that a resident was accepted into medical school is testimony to his/her success at being a marketable item that stood the test of grades, examinations, interviews, and letters of recommen¬ dation. However, obtaining a post¬

must be considered the most difficult of all, considering the limited number of top positions and the quality of the competition. Suffice it to say that it is a long traumatic process, which all of you have gone through, and, hopefully, remember well enough to empathize with those of us who apply to your programs.

graduate position

NONPRODUCTIVE EARLY ACCEPTANCE PRACTICES What do the various training pro¬ grams have to offer to ensure that

they obtain the best possible resi¬

dents? This is a crucial issue. The time-tested standards still hold true. The superior training program must offer the following criteria: a highly respected faculty to work with; a reasonable work load; a competitive salary; and a safe, desirable location. What, then, does the applicant have to offer the training program? The most desirable quality of any resident is his/her ability to perform as a responsible physician. The crush of

surgical specialty training programs (out of medi¬ cal school) denies them a crucial year of clinical experience—the surgical internship-available to them as the ultimate evaluation of an applicant's performance. Whatever security might be gained for both the applicant

to select applicants early

and the program in

selecting appli¬ early ignores the practical,

the

fundamental statements of level of responsibility, industriousness, knowl¬ edge, and ability to get along with patients and fellow staff members, which is so thoroughly documented monthly by the heads of various services through which surgical in¬

right choice," and 19 (48.7%) thought that they "probably made the right decision." A sobering point remains that five (12.8%) of these residents were having second thoughts about their first year of resi¬ dency, three (7.6%) were considering changing their field, and two (5.1%) were actually in the process of doing

terns rotate.

so.

cants

RETROSPECTIVE SURVEY OF RESIDENTS

What are the retrospective view¬ points of the first-year resident about the selection process? Is the student ready to make a decision after three

years of medical school? I can assure you that he/she is not. A study was conducted of first-year general sur¬ gery residents at the UCLA School of Medicine, Los Angeles, and a number of my classmates from The Baylor College of Medicine, Houston, who are in a variety of internships across the country. I tried to get a general idea from this total of 39 individuals as to their degree of certainty with regard to future career decisions. The first question was as follows: Do you know for certain what field of medicine you will eventually enter? Five persons (12.8%) had "absolutely no idea" at the time they were applying for their internship, and another five (12.8%) stated they were "absolutely certain." The remaining 29 (74.4%) of those surveyed were in the middle and thought they were "probably certain" that they were ready to make a deci¬ sion. The second question was as follows: When you originally applied for your internship at the end of your third, or beginning of your fourth year of medical school, how certain were you that you were making the right choice? Twenty-six (66.6%) resi¬ dents thought they were "reasonably certain," eight (20.5%) said they "had their doubts," and only five (12.8%) were "absolutely certain" they were making the right choice of internship at that time. The next question is equally important: Now that you are a year past the match, and you are actually into your internship, what do you think about your residency choice? Encouragingly, ten (25.6%) residents thought that they "absolutely made

How does one interpret these data? Only one fourth of the first-year resi¬ dents who were sampled were certain that they made the right decision. A disconcerting 25% were considering or were actually changing their type of residency. In my next question, I asked whether they thought career decisions

were

forced

on

them too residents

early. Twenty-nine (74.3%) thought very strongly that they were. Only two (5.1%) disagreed, and the remaining eight thought that this was not applicable for their fields of medi¬ cine.

Perhaps there is even greater impact in the following comments of the surveyed first-year residents: "It

is ridiculous. You need to 'do it' to know if you like it, and you need to do it as a resident, not as a student. To get the exposure required to make an informed decision would probably require a four-year medical school program and a rotating internship for many people." "Programs which force early decisions probably suffer some¬ what themselves because some of their constituents make decisions they're uncertain of, and I disapprove of early acceptance programs." Final¬ ly, this comment came from a UCLA resident: "Early application for the subspecialties, in itself, is sufficient to rule them out for me. I was neutral to them, but because of the early applica¬ tion I would not even look into them." The next question on the survey was how a student could avoid having to make these decisions so early. The following answers were very similar and quite logical: "In most cases, this could be avoided if all the top ten or 12 programs in the country agreed to put a moratorium on new applicants for almost two years and then, as a group, renewed their admissions process." "Why not just arrange the specialty

residencies

one

year in

advance, like

everything else. Apply by Nov 1, give

interview dates, acceptance dates, and then allow us to give the final accep¬ tance decision, not in a matching sequence, but where we would like to go as opposed to where we were matched." The final question was as follows: Should the surgical specialty pro¬ grams be decided according to a matching process? Seventeen (43.6%) residents were opposed to a matching program for surgical specialties. Eight (20.5%) thought it was a fairly good idea, and it was nonapplicable for the remainder. The viewpoint of those residents who were opposed to a surgical matching program is ex¬ pressed by one of the respondents who said. "I was disappointed with the results of the matching program, and I'm afraid a similar match would leave one with the feeling of having little choice of career and ability to change if unsatisfied. The eight residents who thought that a match might be a good idea said its greatest advantage was that it would allow for a specific date of acceptance to the specialty program. COMMENT

I would like to make a brief comment in closing. The internship matching program is a necessary evil

for

dealing with thousands of appli¬ are competing for hundreds of different types of internships. But where the number of surgical special¬ ty positions are limited, I strongly think that enough coordination and cooperation could be mustered to make the procedure one that is most advantageous to both the applicant and the residency program. First of all, positions should not be finalized or offered until one year before they are available. Above all, the teaching institutions must keep in close contact with each other, set down firm guide¬

cants who

lines

as

to the selection process, and

place strict timetables for acceptance,

which must not be violated. In this way, the surgical specialty programs can assure themselves high-quality house staff members who are firm in their commitment to the program and happy with their residency choice.

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The matching program from a first-year resident's viewpoint.

The Matching Program From a First-Year Resident's Viewpoint Lawrence Koplin, MD matching The residency occurred program, which in March 1976, was...
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