Postinterview communication with residency applicants: a call for clarity!




The residency match is an increasingly competitive process. Communication from medical student applicants to programs varies, and the effect this has on their rank status is unclear. We assessed how obstetrics and gynecology program directors interpret and act on postinterview communication initiated by applicants by conducting an anonymous cross-sectional web-based survey of allopathic obstetrics and gynecology program directors. One hundred thirty-seven program directors (55%) responded to the survey. Twenty-nine percent would consider ranking an applicant more favorably if the applicant expressed interest (beyond a routine thank you) or if a faculty mentor personally known to the program director stated that the applicant was ranking the program first. Fifty-two percent indicated that they would rank an applicant more favorably if a mentor known to them endorsed the applicant as outstanding. Approximately 30% responded that applicants who did not communicate with their program were disadvantaged compared with those who did. Approximately 17% stated it was desirable to create additional specialty-specific guidelines regarding postinterview contact between programs and applications. Based on the wide variation in how program directors interpret and act on postinterview communication from applicants, residency programs should formulate and communicate a clear policy about whether they request and how they respond to postinterview communication from applicants and their mentors. This will establish a more level playing field and eliminate potential inequities resulting from inconsistent communication practices.


The Problem


The wide variation in how program directors interpret and act on postinterview communication may result in inequities for applicants as they decide whether to contact programs and what to say.




A Solution


Residency programs should formulate and communicate a clear policy about whether they request and how they respond to postinterview communication from applicants and their mentors.




A Solution


Residency programs should formulate and communicate a clear policy about whether they request and how they respond to postinterview communication from applicants and their mentors.




Surveying program directors


We assessed how obstetrics and gynecology program directors interpret and act on postinterview communication initiated by applicants by conducting an anonymous cross-sectional, web-based survey. The program directors of allopathic residency training programs were identified via the Council on Resident Education in Obstetrics and Gynecology directory. This study was determined by the Institutional Review Board of the Women and Infants Women and Infants Hospital of Brown University to be exempt from review.


To optimize the response rate, the 5 regional representatives to the Council on Resident Education in Obstetrics and Gynecology Council e-mailed their regional obstetrics and gynecology program directors to inform them about the study. We distributed the survey to the program directors using Dat Stat Illume (Seattle, WA). Participants were tracked using a password-protected Access database that was accessed only by the statistician. Each program director was linked to a specific survey, thereby preventing repeated entries. As many as 2 additional requests for participation were sent.


Survey questions consisted of global statements concerning the program director’s perception of an applicant’s rank intentions and the impact of that perception on the director’s actual ranking of that applicant. We obtained demographic data on how long the respondents had been a program director and elicited opinions as to whether additional guidelines surrounding postinterview contact should be developed.


Using SAS version 9.2 (SAS Institute, Cary, NC), we evaluated whether the advice that program directors provided medical students regarding postinterview contact was influenced by whether they believed the postinterview contact that they received. Categorical variables (eg, whether program directors believed postinterview contact statements by medical students or their mentors) were compared by χ 2 or the Fisher exact test. McNemar’s test was used to compare nonconcordant responses between survey questions. All P values presented are two tailed with P < .05 considered statistically significant.


Of 249 surveys distributed, 137 were returned (55%). We analyzed the surveys from those 132 program directors who responded to at least 85% of the questions. This response rate, although consistent with comparable physician survey-based studies, raises some potential for nonresponse or selection bias.




Revealing ranking preferences


Sixty-one percent stated that they believed an applicant’s statement that he/she was ranking them number 1 (95% confidence interval [CI], 52–70%) and 40% stated that they believed an applicant’s mentor’s statement that the applicant was ranking them number 1 (95% CI, 32–49%).


Program directors were more likely to believe an applicant was ranking them number 1 if the candidate explicitly stated this (ie, “ranking you number 1”) compared with all other statements of intent (eg, stating ranking “at the very top”) ( P = .0004). Twenty-nine percent (95% CI, 21–37%) stated that they would consider ranking an applicant more favorably on their rank list if the applicant expressed interest (beyond a routine thank you) or if a faculty mentor personally known to the program director stated that the applicant was ranking the program first.


Different types of postinterview communication had a varied impact on residency ranking. Suggesting that a personal relationship carries the most powerful impact, just more than half of program directors (52.3%, 95% CI, 43–61%) indicated that they would consider moving an applicant up if contacted by a mentor known to them who endorsed the applicant as outstanding. In contrast, only 17.4% (95% CI, 11–25%) would move an applicant up as a response to an applicant communicating to the program director that they were ranking them number 1. Thirty percent (95% CI, 22–38%) (n = 39) of program directors responded that applicants who did not contact their program were disadvantaged compared with those who did.




Counseling medical students


One hundred seven program directors (81%) (95% CI, 73–87%) counseled medical students at their institution about postinterview communication. Thirty-eight program directors (35.5%) (95% CI, 26–45%) advised students to inform only their first choice that they were ranking them first, 21 (19.6%) (95% CI, 13–28%) advised students not to inform their first choice, and 48 (44.9%) (95% CI, 35–55%) provided no advice in this regard.


The information program directors provided to students regarding postinterview contact reflected their responses about how they interpreted and acted on contact by applicants and their mentors. Program directors who recommended that students inform only 1 program that they are ranking them first, compared with those who did not give this advice or gave no advice, were more likely to believe applicants and mentors contacting them with this information.


Similarly, these program directors were more likely to move applicants upward on their rank list based on their postinterview communication. Of the 38 program directors who advised students to inform only their first choice that they were ranking them first, 89.5% (95% CI, 75–97%) believed an applicant’s statement compared with 47.6% (95% CI, 26–70%) who advised students to not inform their first choice, and 45.8% (95% CI, 31–61%) who did not provide advice on this.


Comparable trends were seen based on students’ mentors’ statements as well as how this information influenced the program directors’ rank order. Similarly, program directors who counseled their students to have a mentor contact programs were more likely to be influenced by contact from an applicant’s faculty mentor.




Formal policy about communication


Only 15 program directors had a formal policy regarding postinterview season communication in place (11.4%) (95% CI, 6–18%). None of these program directors would move an applicant upward based on contact by a known faculty mentor. In contrast, 32.5% (n = 38) (95% CI, 24–42%) of program directors who did not have a policy reported that they would move an applicant more favorably on the rank list as a result of mentor contact ( P = .006).


We asked program directors about their opinions on guidelines for postresidency interview contact. Only twenty-two (17%) (95% CI, 11–24%) responded that specific guidelines (in addition to the guidelines already in place) should be developed. However, compared with the program directors who did not think that guidelines for postresidency interview contact should be developed, these program directors were more likely to think that only applicants should initiate contact (32% vs 12%, P = .05), that specific wording should be used or avoided to express enthusiasm for a program (41% vs 18%, P = .03), and that national guidelines should be adopted for all programs (82% vs 46%, P = .002).




Impact of having no policy


Applications for obstetrics and gynecology residency positions are becoming increasingly competitive. Studies in other fields including urology, family practice, and general surgery have shown that postinterview communication is commonly suggested by programs. Advice given to applicants from residency programs ranges from telling applicants to keep in touch if they are interested, to telling applicants to specifically contact them if their program was their top choice.


Students are clearly communicating with programs after their interview, often including statements about rank intent. Of 564 medical students at 7 medical schools completing a survey on postinterview communication, 62.9% stated that they told a single program that it would be ranked first. A resident applicant who was a member of the NRMP’s Board of Directors reported that only 1 of the 10 programs at which they interviewed had a policy stating that all postinterview contacts were voluntary and would not affect applicants’ standing. This applicant interpreted the absence of a stated policy from the other programs as meaning that expressions of interest would be used in the ranking process.


There appears to be a clear dichotomy in the attitudes and practices of obstetrics and gynecology program directors. The majority of respondents to our survey ( Appendix ) did not believe postinterview communication played a significant role in their rank order list. Nevertheless, approximately one-third of program directors reported that they do counsel students to alert the single program that is their first choice and may themselves move an applicant who expressed interest upward, more favorably, on their own rank list. Thus, in the eyes of those program directors who might act on postinterview communication, applicants who have no contact are disadvantaged.

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May 10, 2017 | Posted by in GYNECOLOGY | Comments Off on Postinterview communication with residency applicants: a call for clarity!

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