Most academic surgeons strive to practice evidence-based medicine: we critically evaluate the literature and apply it to patient care in order to deliver the best possible outcomes. Unfortunately, the same cannot be said for how we select our residents. For many general surgery residency programs, the process seems rather…arbitrary. With the caveat that this is my opinion, based purely on non-scientific observations and conservations with colleagues, here is my list of the top things that residency programs can do to improve their resident selection process.
- Have a template for the ideal candidate.
Residency programs vary greatly in their size and environment; independent programs may have very different training goals from medical school-based programs. Does the program mostly train residents who will practice in underserved communities, or do their graduates go into academia? How important is research experience for the residency program? Do the majority of the residents go into fellowship training after graduation? The answer to these questions determines what the “ideal” resident applicant should look like. If the department chair, program director, and core faculty members are not on the same page about what they see as the “ideal” candidate, confusion can result. In order to succeed in recruiting and selecting the best possible resident applicants, the program needs to share a common vision on what the ideal applicant is.
- Don’t over-emphasize standardized test results.
At this time, USMLE exam scores are the only universal metric that all medical students share. As such, program directors have long utilized it for comparing and screening applicants.1 In addition, they are predictive of future standardized test performance, both for the ABSITE and the ABS Qualifying and Certifying Examinations.2 Since residency programs are judged to some degree on their trainees’ board pass rates, it is only natural that USMLE scores serve as an important component of the selection criteria. However, they are generally poor predictors of clinical performance during residency.3 Anecdotally, most of us have probably have had the experience of a resident who is book smart, but “just doesn’t get it” when it comes the patient care or operative technique. Knowledge base is only one aspect of good surgical training. It is important for programs to be cognizant of the limitations of standardized test results as measures of future success in residency.
- Formulate a strategy to compare students from different medical schools.
There is a great deal of heterogeneity in how medical schools grade their students. Some assign traditional letter grades, others are pass-fail. Some report GPAs, others report class rankings. This makes comparisons between applicants difficult; is applicant A, with a GPA of 3.5 and class rank of 25 out of 150 graduates from one medical school, better suited for residency than applicant B, with a GPA of 3.7 and class rank of 30 out of 100 from another medical school? A predetermined strategy or algorithm for how to deal with these apples-to-oranges comparisons is needed to streamline ranking decisions. Without such a system, programs will end up making these decisions on a case-by-case basis – very inefficient.
- Maximize the utility of interviews.
Research from the human resource management industry has revealed several “best practices” in regards to how employment interviews should be conducted.4 Unfortunately, it appears that very few general surgery residency programs utilize such best practices, such as the use of blinded interviews or structured/standardized interview questions. This results in the introduction of bias and diminishes the ability of interviews to yield unique information about the applicants that wasn’t readily apparent on paper. Effective interviews add to the program’s understanding of the applicant qualifications and skills, rather than just reinforce the pre-interview data. By utilizing these best practices from other industries, programs can maximize the utility of their in-person interviews.
- Try to evaluate non-technical skills.
I think many surgeons would agree that qualities such as sound judgment and decision-making, strong work ethic, “grit”, problem solving skills, and “teachability”, are probably more important in determining an applicant’s suitability as a future surgeon than his or her ability to select the correct response on a multiple-choice question test. However, these are often the qualities that we spend the least amount of time evaluating during the resident selection process. As Sir William Thomson stated, “In physical science a first essential step in the direction of learning any subject is to find principles of numerical reckoning and practicable methods for measuring some quality connected with it. I often say that when you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind.”5
There is no easy formula for how to select general surgery residency applicants; each program has unique goals and challenges in recruiting future residents. However, I hope that this list gives some food for thought for other academic surgeons, and I am eager to hear what ideas others have on resident selection. What do you do at your residency program? What things have worked in the past? What hasn’t worked?
- Makdisi G, Takeuchi T, Rodriguez J, et al. How we select our residents–a survey of selection criteria in general surgery residents. J Surg Educ. 2011 2011 Jan-Feb;68(1):67-72.
- de Virgilio C, Yaghoubian A, Kaji A, et al. Predicting performance on the American Board of Surgery qualifying and certifying examinations: a multi-institutional study. Arch Surg. 2010 Sep;145(9):852-6.
- McGaghie WC, Cohen ER, Wayne DB. Are United States Medical Licensing Exam Step 1 and 2 scores valid measures for postgraduate medical residency selection decisions? Acad Med. 2011 Jan;86(1):48-52.
- Huffcutt AI. From Science to Practice: Seven Principles for Conducting Employment Interviews. Applied HRM Research. 2010;12(1):121-36.
- Thomson, W. From lecture to the Institution of Civil Engineers, London (3 May 1883), ‘Electrical Units of Measurement’, Popular Lectures and Addresses (1889), Vol. 1, 80-81.