MSPE, Test Scores, Interview Are Big Factors in Programs' Choice of Residents

Medical students interested in matching to family medicine residency slots this year should be aware that the results of their Medical Student Performance Evaluation, or MSPE; grades in their clerkships; letters of recommendation; and standardized test scores are among the most important factors in getting interviewed and ranked by the residency programs to which they have applied. That heads-up comes from the preliminary results of a recent National Resident Matching Program, or NRMP, survey (144-page PDF; About PDFs) of program directors who participated in the 2008 residency Match.

Directors of 1,840 residency programs in the 19 largest specialties responded to the survey, which was designed to shed light on the factors used to select applicants to interview and to rank them for the Match. Of that total, 282 family medicine program directors responded.

The survey was fielded during the 19 days between the rank order list deadline and Match Week so that program match outcomes would not influence respondents' answers. The survey solicited information on the number of applications received, screened and reviewed at each program, as well as on the number of applicants interviewed and ranked. It also specifically asked about the use of test scores in considering which applicants to interview, the factors used for both interview selection and applicant ranking, and other aspects of the annual matching process.

From among nine measures of medical school performance, 72 percent of family medicine program directors cited students' MSPE results as a factor in selecting applicants to interview. Sixty-two percent listed grades in required clerkships as a deciding factor.

A large proportion of program directors -- 85 percent -- cited scores on the United States Medical Licensing Examination/Comprehensive Osteopathic Medical Licensing Examination, or USMLE/COMLEX, Step 1 as a factor in choosing applicants to interview; 79 percent cited scores on the USMLE/COMLEX Step 2 as a factor.

According to the survey, most family medicine residency directors who responded required program applicants only to pass the USMLE Steps 1 and 2 before they would consider interviewing them. But many program directors also reported that they "seldom" considered applicants who failed either exam on their first attempt.

Sixty percent of programs cited graduation from a U.S. allopathic medical school as a factor in selecting applicants to interview.

Letters of recommendation were important, with 68 percent of family medicine program directors reporting that a letter from a student's academic department chair was a factor in deciding whether to interview the student. Recommendation letters from other sources -- a specialty colleague, a specialty clerkship director or other faculty members -- ranked even higher.

Factors other than academic performance also were evaluated in deciding which applicants to interview. Candidates' personal statements were cited by 83 percent of the family medicine programs polled as a determining factor; 60 percent listed volunteer/extracurricular experiences. "Perceived commitment to the specialty" and "personal prior knowledge of the applicant" came in at 76 percent and 65 percent, respectively, in selecting interviewees.

Among factors considered when ranking program applicants who had completed the interview process, specialty clerkship grades, MSPE results, and scores on the USMLE/COMLEX Steps 1 and 2 were again cited as important by family medicine program directors. Also frequently cited were letters of recommendation from specialty clerkship directors and whether students had graduated from allopathic medical schools in the United States.

The residency interview was key in determining each applicant's ranking, with program directors evaluating such factors as the applicant's interpersonal skills, interactions with faculty, demonstration of professional attributes, interactions with house staff and perceived commitment to the specialty. Feedback from current residents also was often sought.

Perry Pugno, M.D., M.P.H., director of the Academy's Division of Medical Education, told AAFP News Now that he was not surprised by the survey findings. Family medicine residency programs use many different criteria in deciding whether to interview applicants, he said. "But once an applicant interviews at a program," Pugno noted, "then I believe the decision to rank an applicant is based largely on the perceived 'fit' of that individual with the program and residents there."

He said applicants informally rank residency programs, too, based on geographic location, the quality of education they anticipate from the program, and "how comfortable they feel with the residents and faculty."

"My 20 years of experience with surveying applicants after the Match have been quite consistent that those (criteria) are indeed true," Pugno said.