Predicting the Future
Predicting and preparing for the next swing in the otolaryngology match is a difficult exercise at best, said Dr. Chang. “It’s kind of like predicting the stock market, then tweaking one thing after another to try to see what really makes a difference.”
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February 2020“If I had to guess, I think there will be some really low and some really high application spikes over the next five to 10 years as students talk to each other and to the next class down,” said Dr. Cabrera-Muffly. “When we tried to stabilize match numbers, it didn’t work very well, and there were some unintended, unpredictable consequences.”
One thing that could make the process easier for residency programs is the addition of more subjective measures on which to base a decision.
“We do look for excellent letters of recommendation, but I’ve seen only a handful of letters in my eight years of reviewing applications that were negative,” said Dr. Cabrera-Muffly. “Many medical schools are going to a pass/fail curriculum, and sometimes transcripts are difficult to parse out because they aren’t labeled ‘A, B, C, D, F’—they’re labeled ‘excellent’ or ‘outstanding.’”
Dr. Chang noted that while the United States Medical Licensing Examination (USMLE) score can provide an objective measure, giving it too much significance can be detrimental. “The USMLE score is one of the hard numbers you can get out of an application that’s easily comparable across the spectrum,” he explained. “But if every program uses it as their main ranking measure, they may end up chasing after the same group of applicants.”
One possibility is a system that encourages applicants to signal their actual preferences for programs. “I’ve read about a ‘star’ system where applicants have, say, 10 stars to allocate to their top program choices,” said Dr. Cabrera-Muffly. “I think that would make a difference for smaller programs. If you have someone who clearly wants to be at your program, that motivation translates into being a good resident.”
“I’ve heard several ideas discussed, including a tiered application process where residents can apply to a given number of programs initially; the programs respond to the first tier, and then, if applicants get all the interviews in their first tier, they don’t apply to a second set,” added Dr. Abaza. “It allows programs to know applicants’ first choices, and it may help curb getting applications from students who are padding their numbers but aren’t likely to choose the program.”
While cause-and-effect opinions on the match differ, one thing that most agree on is the need to be more transparent. “I think we need to find ways to let applicants be honest about their wants and needs—not just in otolaryngology but in all competitive specialties,” said Dr. Abaza. “And we have to be honest, with the applicants and with ourselves, about who will be successful rather than who we think we should take because of the prestige of their background.”
The ultimate goal of the match is for applicants to find a residency that fits their needs, and for residencies to find applicants that best match their goals and objectives, said Dr. Chang. “But much like a first date, you don’t always know each other’s hidden objectives because everyone’s trying to put a good face forward. In the end, I don’t think anyone will ever be completely transparent because everyone has an overwhelming interest in simply matching.”
“I think that, although there have been up-and-down swings, the underlying interest in otolaryngology has always been there,” added Dr. Stewart. “We’re now doing a better job of directing that interest, and that’s a very positive thing for our specialty overall.”