1. Residency selection Who to take?
Who not to take…..
Jack Choueka, MD
Chairman/Program Director
Maimonides Medical Center
Brooklyn, NY

2. Disclosures
Reviewer – JHS
Speaker – Xiaflex
Instructor - Synthes

4. Easier to get rid of your spouse than a resident

5. 7% of all matched residents require substantial remediation or dismissal from residency training

6. Taking the wrong resident
Decrease morale
Decrease work efficiency
Patient care
Faculty disillusionment
Adverse effect on recruitment

7. Who would you take??

8. Local
245
AOA
Good research
No rotation
OK Interview
Great letters
Regional
230
Not AOA
Some research
Great rotation
Great Interview
Bad Eval in OB/GYN
Distant
275
No research
Good Interview
Bland letters

9. ERAS Education History Work/Volunteer/Research Experience USMLE Scores
Personal Statement
Letters of Recommendation (LOR)
Deans Letter
Transcript
AOA, Honors, Awards
Other Factors: felonies, couples match, military obligation, citizenship/Visa requirements

10. What we do Set filters (med school, board scores)
Assign reviewers who actually will read the applications
Each application reviewed by at least 2 reviewers
Offer interviews when consensus occurs

11. AOA Steering Committee
Cognitive skills
Motor Ability
Affective domain

12. AOA Steering Committee
Cognitive skills = Pass boards
Motor Ability = Can operate
Affective domain = Won’t torture you

13. Evidence Based??

14. USLME Poor correlation with clinical skill acquisition
Correlates only when outcome is another multiple choice test
McGaghie et al. “Are the USMLE Step 1 and 2 Scores Valid Measures of Postgraduate Medical Residency Selection Decisions?” Acad Med. 2011; 86:48-52.

15. Professionalism
Determine whether standardized admissions data in ERAS were associated with assessments of professionalism
Comparative statements in LORs (p=.002).
Cullen, et al. “Selection Criteria for IM Residency Applicants and Professionalism Ratings During Internship”. Mayo Clin Proc. 2011; 86(3):

16. Orthopaedic Specific Research

17. No faculty consensus about ranking of residents upon graduation
“Resident Selection: how are we doing and why?” Thordarson, et al. Clinical Orthopedics and Related Research 2007
Fair/poor correlations noted between residents’ initial and graduation rankings
No faculty consensus about ranking of residents upon graduation

18. Dirschl et al. “Resident selection and predictors of performance: can we be evidence based?” Clinical Orthopedics and Related Research 2006
Objective: To determine if an academic score, using objective elements only, will discriminate among applicants and correlate with resident outcomes
Conclusion: Calculating academic score makes application screening process more objective does not appear to correlate with outcomes of the training program

19. Affective Domain Rated as high importance for PD’s
Correlates with number of medical school honors (Dirschl 2002)

20. Predictors of Residency Success
Charitable involvement
Varsity sports – selection to chief resident
(Spitzer et al HJD 2009)

21. Summary No real consensus on good predictors
Outcome measures vary among studies
Faculty evaluations too inconsistent
Program specific

22. Milestones may provide more universal outcome measures

23. My Reality Most residents pass their boards
Most residents will make you proud
Even the difficult ones find their way

24. ….But I need to get through the day

25. Program Fit
Hospital’s culture
Know your faculty
Resident environment

26. Hospital Culture Patient mix Languages Other residency programs
Hospital perception of residents
Institutional opportunities

27. Faculty
Clinical vs. Academic
Teaching style
Specific mentor

28. Your Residents
Which ones thrive
Hierarchy
Diversity

29. Our culture Highly diverse patients pop. 73 languages Extreme VIPism
Large residencies in other specialties with large numbers of IMG’s
Residents Included at many administrative levels
Small busy program = cross coverage

30. Traits we look for Leadership Independent Teaching ability
Team players
Inspirational
Ethical
Potential faculty

31. Past experience determines future performance
Know the traits you want
Ask for specifics
Let them do the talking

32. 80% of US applicants Match
They pick you more than you pick them

33. The match curve
Program
Top
Middle
Bottom
Middle
Bottom
Top
Applicant

34. The match curve
Program
Top
Middle
Bottom
Middle
Bottom
Top
Applicant

35. The match curve
Program
Top
Middle
Bottom
Middle
Bottom
Top
Applicant

36. The match curve
Program
Top
Middle
Bottom
Middle
Bottom
Top
Applicant

37. Things that tip your position on the match curve
Program size
Academic affiliations
Location
Institutional viability
High turnover of faculty
Unhappy residents
Disorganized selection process

38. Improve your position Respect the candidates Good communication
Prepared for interviews
Engaged faculty and residents
Lunch
Interview reception
Website/social media

42. Making the rank list

43. Develop ranking system
Be consistent
Rankers
Criteria
Include residents in interview

45. The Shoe-in
Tend to move down the list
If you want them take them

46. The overqualified candidate
Would you take them without the resume
Do they have passion for the program
Same qualities that make them overqualified probably makes them adapt

47. Board Scores
Decide on minimum requirement and don’t look back

48. Call references

49. Most important rank Last one on the list
Would rather have that person than nobody

50. What if you don’t fill Don’t panic Plenty of good applicants
Take your time
Review applicants
Mini interview session
Listen to references

51. Thank You