How’s your fadeaway jump shot? That question would likely throw off any physician applying for otolaryngology residency training, but a new study looking at predictors of success as an otolaryngologist suggests that this might be the very question residency program directors should be asking.
Typically, United States Medical Licensing Examination (USMLE) scores, letters of recommendation and medical school grades are the qualifications on which most resident choices are made, but this recent retrospective review published in the Archives of Otolaryngology-Head and Neck Surgery found that those factors aren’t particularly indicative of a successful otolaryngologist (2012;138(8):707-712). In fact, serious participation in athletic activities was the best determiner of a good clinician, according to the study, which used overall ratings of the graduates given by clinical faculty to determine participant scores.
This news may be a bit of a blow to applicants who have spent the last eight years or so focused on the standard measures of success, said Richard A. Chole, MD, PhD, Lindburg Professor and chairman of the department of otolaryngology at Washington University in St. Louis School of Medicine in Missouri, who conducted the study with M. Allison Ogden, MD, an assistant professor of otolaryngology at the same university. “The way medicine goes now, a lot of kids go through high school, college, medical school and residency without having any experiences in which they learn to interact with their peers and supervisors in a productive manner,” he said. “They’re usually spending all of their time studying and working on good grades, often in relative isolation.”
For that reason, Anna Messner, MD, residency and pediatric otolaryngology/head and neck surgery program director at Stanford University School of Medicine in Stanford, Calif., said the correlation between participation in a team sport and proficiency as a clinician makes perfect sense. Noting that residency directors have known for a while that test performance and having good grades doesn’t necessarily mean you’ll be an excellent physician, she added, “In a team sport, you learn how to support your colleagues, you learn how to interact with your colleagues, you work hard and you achieve a positive outcome together—and those are the same things we do in medicine.”
A program that is structured in such a way as to hire or retain experienced hospitalists is likely to have a higher cost savings than one that doesn’t.
—Anna Messner, MD, Stanford University Medical Center
No Profession for a Lone Ranger
Interestingly, Dr. Chole wasn’t expecting to find anything discussion-worthy about athletic excellence when he began this study two years ago. He first started asking faculty to rate graduates of their training program as an internal quality assessment project, but he began noticing a trend that showed a lot of the higher-ranking physicians had in fact participated in a team sport. At that point, he decided to include that measure in the regression analysis he completed on the 46 graduates from their residency program over the past 10 years.
For the output, Dr. Chole used the five-point scale ratings faculty members gave the graduates, while the input consisted of the following factors: MLE scores, Alpha Omega Alpha Honor Medical Society election, medical school grades, letter of recommendation, rank of the medical school, residency interview, experience as an acting intern and extracurricular activities. The analysis revealed that letters of recommendation, experience as an acting intern and musical excellence showed no correlation with higher faculty rating. Further, rank of the medical school and faculty interview were weakly correlated with the faculty rating, while excellence in a team sport actually correlated with a higher faculty rating.
While Dr. Chole was surprised by the lack of correlation between the objective measures residency programs currently use, he understands the value team sports provide. “Activities where residents have to assume responsibility and hold others accountable are good indicators of success, because working in medicine now is a team [endeavor],” he said. “You can’t work as a lone ranger anymore.”
On the rating scale for physicians in the study, residents who accomplished individual achievements in athletics, such as running, weight lifting or gymnastics, were assigned one point on the grading scale. Those who had a history of athletic achievement in a team sport, such as soccer, basketball or football, received two points. Though team sports experience was weighted more heavily than individual athletics, Dr. Chole said participation in either should yield a similar benefit.
Mark Wax, MD, director of otolaryngology/head and neck surgery residency training at Oregon Health and Science University School of Medicine in Portland, Ore., agreed. “If you participate in sports, even if it’s something independent, it still involves coaching. Most sports may not be like football, with nine people on the field who need to interact, but if you’re doing track and field, you still have coaches you have to work with and take direction from, and that helps.”
Overall, the problem solving and conflict resolution skills built by participation in a sport are most critical, Dr. Wax added. “As a program director, I find it very rare for disciplinary, personality and professional issues to get up to my level. I may hear of situations or issues, but it’s usually taken care of by senior or chief residents because they perceive themselves as all [being] on one team, and the team can’t run smoothly with these issues.”
What Do You Do with This?
Although this study has generated significant buzz, questions as to just how much weight should be placed on this finding remain unanswered. Robert J. Sinard, MD, program director of otolaryngology at Vanderbilt University Medical Center in Nashville, considered the association found in the study to be interesting, but “it’s a bit of information that I’m really not sure what you do with,” he said.
“I’ve been educating residents for 17 or 18 years, and there are some who I know competed on a very high level of team sport who were not especially good residents, and when I think of some of the absolute top people I’ve ever trained in my whole life, I’m not sure that any of them were team sport competitors,” he said.
“As a generalization, [this finding] may be helpful, but it certainly won’t help us decide definitively between candidates.”
Dr. Messner expressed a similar sentiment, saying that Stanford’s program considers participation in a team sport as part of the overall package. “The weight we give it is not overwhelming,” she said. “Just because someone has participated in a team sport doesn’t mean we’ll rank them highly, but we do consider it.”
Dr. Chole said that he and Dr. Ogden don’t currently have any concrete plans to continue this research, but they have used the data to adjust their application review process.
“We’re not rating USMLE scores as highly as we did before,” he said. “Generally, we don’t look at dean’s letters very much at all, because they don’t really tell us much and each school is quite different. We do look at scores, grades and so forth, but we don’t rate them as heavily. We’re looking more at the whole person and trying to prognosticate how they’re going to do.”
In terms of general applicability for the otolaryngology field as a whole, Dr. Chole added, “This isn’t the absolute proof of anything, but an observation. Hopefully, this is food for thought for up-and-coming otolaryngology leaders to take the baton and take this study further.”
The Total Package
While the experts interviewed for this article may not specifically be looking at athletic prowess when choosing resident candidates, all of the program directors mentioned that their final choice comes down to the few people who embody the “total package.” So what exactly does that mean?
Beyond the standard factors included in the study, such as USMLE scores, letters of recommendation and grades, Dr. Messner said Stanford also considers leadership positions applicants have held, the number of papers published, research background and even charitable work.
At OHSU, Dr. Wax said three different people review the candidates, judging them using specific criteria, with some placing more weight on personal statements and presentations and others relying more heavily on letters of reference. But, with the quality of candidates so high, he said the one characteristic that usually seals the final deal is attitude. “When you deal with such a fantastic group of people who apply to programs and are already in the top 1 percent [of medical school graduates], to be honest, after we finish our interview sessions, 80 percent of the people we interview we’d be happy with. A lot of the times, the choice is just a personality issue based on who you got along with better in the interview.”—BV