COVID-19, emergency medicine match
The match has evolved technically and culturally since 1952 into one of the most important and anxiety-provoking rituals of medical school education. Third-year medical students prepare their applications to the National Residency Matching Program (NRMP) at great personal expense, not just in money but in time and effort.
Information technology since the turn of the millennium has had an enormous impact on how the NRMP operates. The increased efficiency of an internet-based application process created an unintended consequence not possible when I attended medical school. The application process back in the 1980s used paper forms and snail mail. Consequently, logistical barriers limited the number of programs to which someone could apply, but the instantaneous digital movement of data now only requires applicants to make an extra click to apply to one more program. The only real barrier is the additional cost charged by the NRMP to send the information.
The number of applications submitted per U.S. medical student to EM programs increased by a whopping 93 percent from 2011 to 2020. (Association of American Medical Colleges. https://bit.ly/3cUZv3J.) This year alone, U.S. medical students applied to an average of 58 programs, the AAMC reported, at a total cost of $1187. I can tell you from personal experience that the vast majority of applicants on our rank lists for the past two decades got one of their top three or four choices. What is driving this?
The complete answer lies in a combination of variables, but a significant component is the anxiety created by social media and the 24-hour news cycle. (Verywell Mind. March 25, 2020; https://bit.ly/2MVfaFv; NBC News. Dec. 16, 2017; https://nbcnews.to/3fgbnPr.) The perception of scarcity drives up demand, and humans naturally pay more attention to bad news than good; we are always on the lookout for threats, and we willingly overcompensate to avoid pain. Medical students hear from a variety of sources about a few unlucky medical students in the past who did not match, and they panic that they could be one of them. A colossal student debt burden and no job terrify them. But 58 applications?
Enter COVID-19. What will be the ramifications of the first match during a pandemic? The possibilities for chaos seem endless. Every organization involved in emergency medicine education (AAEM, ACOEP, ACEP, CORDEM, EMRA, SAEM, etc.) signed a joint consensus statement with guidelines for the 2021 match, and every EM training program is playing along. (https://bit.ly/2YtMrx9.)
For starters, all interviews will be virtual. Medical students have traveled throughout the country to visit and interview with programs for almost seven decades. This is expensive and time-consuming, but what rational person doesn't want to see where he might spend three to four years of his life and meet who he will entrust with making him into a competent physician? Nonetheless, the consensus statement says that all interviews, even those for an applicant's home institution, should be done virtually.
It stands to reason that applicants who do not have to travel for interviews will be able to interview at even more programs. The consensus statement, however, also requests that medical schools encourage their students to limit the number of interviews at EM programs to 12 with a hard stop at 17. More than 95 percent of all applicants (allopathic, osteopathic, and international medical graduates) who interview with at least 12 programs are successful in the match, according to the statement. Exceptions are allowed for couples matching into programs that traditionally prove to be difficult combinations.
The consensus statement also asks that EM applicants be limited to rotating at their home institution unless their school does not have an EM program. Emergency medicine has a long tradition of applicants participating in at least one off-campus EM rotation at another program. Some applicants do as many as four. Not this year. Following this guideline, each applicant will submit only one standard letter of evaluation (SLOE) instead of the typical two or three.
No doubt, the results of the 2021 match will generate many interesting questions. An obvious one is whether banning travel to interview locations will encourage more graduates to train at their home institution. Another will be the effect of using virtual interviews in the future. Will those applicants who match sight unseen into a residency program prove to be as satisfied with their decision as those who visited in person? Will virtual interviewing become a first step in the interview process and subsequently generate an in-person visit? This seems to be beneficial for applicants looking at programs a long distance from where they attend school.
Finally, will those academic institutions with superior resources for producing marketing content find a strategic advantage in their pursuit of more desirable applicants? Cash-strapped institutions or those with weak information technology may find themselves at a critical disadvantage when trying to lure tech-savvy medical students accustomed to stylish online content designed to influence their decisions. As with many businesses in the digital age, online prowess is a substantial advantage over traditional ways of doing business in medical education.
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Dr. Cookis the program director of the emergency medicine residency at Prisma Health in Columbia, SC. He is also the founder of 3rd Rock Ultrasound (http://emergencyultrasound.com). Friend him atwww.facebook.com/3rdRockUltrasound, follow him on Twitter@3rdRockUS, and read his past columns athttp://bit.ly/EMN-Match.
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