Medical Students Take the Match into Their Own Hands

Remote interviews and virtual campus tours seemed like quick, easy fixes for medical students looking to successfully match with a residency program during the pandemic. And, the process worked – but, now the same method presents what some in academic medicine are dubbing a “clear and present danger” to students and programs alike.

In an opinion piece published Oct. 12 in the Journal of the American College of Radiology, a multi-institutional team led by Anna Rozenshtein, M.D., MPH, associate professor of radiology at New York Medical College and director of thoracic and cardiac imaging at Westchester Medical Center, outlined the potential new playing field for residency programs. It is possible, they said, that many programs will see a significant uptick in applicants – an increase that does not necessarily equate to a vested interest a residency spot, but that could leave other medical students shut out of a coveted place.

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“In the coming match season, residency administrators should keep in mind that a rise in the number of applications and a higher interview acceptance rate from highly qualified applicants do not mean greater interest in either their program or radiology as a specialty,” the team wrote.

As interview season ramps up, the pandemic is lingering and -- in many locations – getting worse. This means residency interviews will occur online, eliminating the need and cost for traveling to see a program first-hand. In the past, 41 percent of medical students reported foregoing an application for financial reasons. With this obstacle removed, it will be much easier for applicants to expand the number of programs to which they apply.

“In the nearly costless scenario, medical students lose nothing from every additional encounter while improving their interviewing skills. Because the most desirable students are usually invited first, we foresee that the competitive cohort is likely to displace other qualified applicants who would have been granted an interview in prior years,” Rozenshtein’s team explained. “If this comes to pass, programs will interview the same applicants, resulting in a smaller rank pool and increase in the number of unfilled positions and unmatched applicants.”

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This phenomenon could have a serious impact on radiology, they said, because the specialty is frequently viewed by many applicants as a “back-up” option. It is possible that medical students who do not have a genuine, deep interest in a radiology residency program could see their application as a chance to sharpen their interview skills with no real intent of committing to the institution.

Online applications are not new to The Match. In 2001, the Electronic Residency Application Service (ERAS) made it easy for medical students to apply to multiple residency programs with a single click. Since then, for radiology, the number of applications per medical school senior has more than doubled, and the number of applications per training programs has more than tripled.

To address this problem and alleviate the impact on radiology residencies, the team offered a solution – a “early action” period, possibly two weeks, at the launch of interview season where ERAS could let medical students apply to a small number of programs, such as 10, in which they had a particular interest. Even though more than 75 percent of radiology residency program directors expressed their interest in the program, ERAS and its parent program, the Association of American Medical Colleges (AAMC) shut down the idea.

This is where medical students stepped in and took matters into their own hands. They created SingleToken, the Residency Application Preference Signaling Platform, and the website is functional now. Through this avenue, medical students pay $25 to profess their interest in the 12 programs of their choice, and residency programs can participate at no cost.

While it is not yet clear if the platform will be able to enroll enough Match participants to make a dent in the increased application congestion for this interview season, the program has potential, the team said.

“If it succeeds, it is likely to do much good,” they wrote. “Since remote residency interviews, like remote work, telemedicine, and online instruction are likely to stay in some form, at the very least Signal and other novel solutions would send a message to the AAMC, ERAS, and [National Residency Matching Program] that ‘business as usual’ cannot continue and urgent reform must take place.”

Still, the team advised, residency programs that opt not to participate in SingleToken or any other congestion solution should focus on increasing their number of interviewed applicants to ensure they fill all positions on Match Day.

This year, they said, radiology residencies “cannot be complacent.”