As the first member of my family going into medicine, I was completely unaware of the vast variety of specialties and subspecialties that I could choose to pursue. As I began learning about each different field, I stumbled upon the Charting Outcomes in the Match data, published by the NRMP every two years. It provides very helpful information on the Match process for prospective applicants and medical students. One statistic that stood out to me was the amount of research experience matriculants had before applying for residency. An average number of 6.9 publications, presentations, and abstracts was reported for U.S. MD seniors who matched into residency in 2020. Even more astonishing were the recorded numbers for some of the competitive specialties, such as neurosurgery (23.4), plastic surgery (19.1), dermatology (19.0), radiation oncology (18.3), orthopaedic surgery (14.3), and ENT (13.7).
However, I realized that there is a high degree of ambiguity in these data, as the numbers are self-reported and contain not only peer-reviewed publications, but also abstracts, presentations, and everything in between. With all of these works grouped together into one metric, I found it difficult to understand what is actually important in the Match.
At MD Anderson Cancer Center, we conducted a bibliometric analysis of peer-reviewed publications published by radiation oncology matriculants before they applied for residency. In addition to comparing research productivity with matching into higher-tier programs via Doximity’s rankings, we looked at how the reported NRMP number compared with the average number of peer-reviewed publications for each matriculant. Not only did we find that higher-tier programs seemed to value meaningful first-author publications in the field of radiation oncology over the total number of publications, we also reported that the average number of peer-reviewed publications published was 2.47 — which is extraordinarily different from the 2020 NRMP reported number of 18.3. Similar contrasts have been published in other fields, such as neurosurgery (5.5 versus 18.3 in 2018), plastic surgery (2.43 versus 14.2 in 2018), dermatology (2.55 versus 14.7 in 2018), orthopaedic surgery (1.6 versus 8.2 in 2017), and ENT (2.76 versus 10.4 in 2018). It is also worth noting that the reported NRMP numbers have increased significantly across these specialties every time a new biennial Charting Outcomes in the Match report is published.
At first glance, it seems as if matching successfully into a chosen specialty requires a ridiculous amount of research, in addition to the various other factors that residency program directors deem to be important, such as Step scores, recommendation letters, and medical school grades. Make no mistake, research is an important piece of a medical student’s career and does demand a high level of effort and commitment. However, it is plain that the current NRMP method of reporting data on matriculant research calls for clarification, as published studies suggest that peer-reviewed publications comprise only a small portion of student research productivity. It is misleading for prospective applicants to peruse the NRMP data and believe that they need to put in the work for X number of peer-reviewed publications for a specific specialty, when the actual number of peer-reviewed publications may only be 20% of X.
Compounding upon this issue is the imminent shifting of Step 1 scores to a pass/fail format. Naturally, this will cause medical students to focus more on their extracurricular activities, with research being a potential spot to target. Given the current numbers displayed in the latest NRMP Charting Outcomes in the Match data, it would certainly not be a surprise. However important research may be for medical education, centering on it could lead to neglecting areas that are also critical to the blossoming of a well-rounded medical student, such as participation in additional learning opportunities and development of leadership skills.
The NRMP should consider reporting publications, presentations, and abstracts in separate categories as a part of its Charting Outcomes in the Match data as soon as possible, beginning as early as in the 2022 edition. By no means is this a perfect solution. However, it is simple, easy to implement, and can provide a crucial bit of transparency to a long and stressful process for the benefit of both medical students and residency program directors.
What do you make of the fact that the NRMP self-reported number of publications is so much higher than the real number? Share your thoughts in the comments below.
Austin Huang is a first year medical student at Baylor College of Medicine and research intern at MD Anderson Cancer Center. Read more at: https://austinwhuang.github.io/
Illustration by April Brust