The Residency Match Process Violates Espoused Values

Imagine you are a surgeon. You are working with your resident, nurses, anesthesiologist, and medical student on a complex procedure. A phone dings. “I am so sorry,” the student says. “It’s interview season — gotta scrub out and check my email!”

Now imagine you are the medical student. You have been away at school for three and a half years. You desperately want to match at a certain residency program. Everything you have done since high school has been for the purpose of achieving this dream. You are an excellent candidate. But for now, you’re trying to train. You hold retractors; the surgeon operates. Ding. You agonize over what your next step should be. If you don’t sign up for an interview slot within the next 10 minutes, you very likely could miss the opportunity to interview at whichever program is emailing you.

Next, the patient. Your abdomen is open. A student retracts tissue as doctors rearrange your bowels. Ding.

Does this seem like a problem to anyone else?

This is the reality that today’s medical students are facing. Residency programs regularly invite hundreds of students to sign up for a limited number of interview slots which are assigned on a first come, first served basis. Often, there will be a second round of interviews offered. Same process. One email. Any time, day or night. Limited slots. No merit involved — just response time.

It may sound like I am being dramatic (I am). But I am not being disingenuous. During interview season, variations of this situation play out across the country perhaps hundreds of times each day.

Imagine all the things that a medical student may want to do without being glued to their phone. Participating in rounds, sleeping, or possibly even enjoying the presence of their loved ones without an incessant, insidious, well founded anxiety that they could be missing out on something vitally important to the trajectory of their lives. This practice is simultaneously leading to the deterioration of medical student mental health and the decimation of educational value during interview scheduling season.

OK — we have identified the problem. That was the easy part. So how do we fix it?

There are several entities involved in varying capacities with the residency match process, including The National Residency Match Program (NRMP), Accreditation Council of Graduate medical education (ACGME), Association of American Medical Colleges (AAMC), and individual academic specialty groups. This list is not exhaustive, but it includes some of the most prominent stakeholders.

The way the system is designed, the onus of treating medical students humanely does not fall squarely on any single organization’s shoulders. No one dropped the ball. No one should be ashamed. However, each of these groups should be scrambling feverishly to rectify our current system.

Medical students, including representatives with the AAMC’s Organization of Student Representatives (OSR), have been kicking around solutions for a while. Suffice to say, solutions exist that would move the interview scheduling process in the right direction, if not outright solve the problem.

The NRMP, in their code of communication conduct, enumerates several specific behaviors that are prohibited for residency programs participating in the match. Many of these restrictions apply to the interview process. Could they not assume the responsibility of governing interview scheduling as well? Can they not simply mandate that participating programs, acknowledging the gravity of the process and respecting students’ concerns, utilize a scheduling modality other than first come, first served?

If the NRMP is unable or unwilling to intervene in this matter, the AAMC and ACGME have a duty to speak loudly and publicly against the practice. As advocates for trainees, they must politely and firmly request the NRMP’s leadership, as the NRMP seems to be the only organization who has the appropriate entities in place to create and enforce such a policy.

I admit up front — this will require significant work, coordination, and systemization. Residency programs, scrounging for resources in the face of abysmal federal funding, may find it difficult to individually adopt more humane processes. High level conversations are required. Resources need to be allocated. Then again, private companies do exist which specialize in scheduling interviews both uniquely regarding the residency match and across other industries.

Medical students are rightly outraged by several factors involved in the match process, ranging from financial considerations to overemphasis on imperfect metrics for evaluating applicants. These quandaries will not be solved quickly. I aim to call attention to one specific area where intervention is feasible and overdue. It is time to end the practice of assigning interviews based upon which student is most successful at prioritizing their cell phone above all else.

Mark Mullen is a third year medical student at Saint Louis University and a member of the AAMC’s Organization of Student Representatives (OSR).

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