How Does Lacking a Home Program Impact Otolaryngology Applicants?

OBJECTIVES: To compare otolaryngology interview and match outcomes between applicants with and without home residency programs. METHODS: Otolaryngology applicants from US allopathic medical schools during the 2019-2023 cycles who responded to the Texas Seeking Transparency in Application to Residency (STAR) survey were identified. Students were stratified based upon whether their medical school had an affiliated otolaryngology residency program. The primary outcomes were number of interviews and match rate. Wilcoxon-rank sum and χ2 testing was used to assess associations between home program status and interview and match outcomes. RESULTS: Of the 633 fourth-year medical students applying to otolaryngology during the 2019-2023 application cycles, 89 had no home program (NHP) and 544 had a home program (HP). Applicants with NHP completed significantly more away rotations than applicants with a HP (2.2 vs. 1.5; p < 0.01). There was no difference in mean number of applications submitted between applicants with NHP and applicants with a HP. However, applicants with a HP received a significantly greater number of interviews (14.7 vs. 11.8; p < 0.01), attended more interviews (12.4 vs. 11.3; p = 0.02), attended a lower percentage of their offered interviews (84.4% vs. 95.8%), and had a higher match rate (81.8% vs. 70.8%; p = 0.02) than applicants with NHP. Applicants with NHP interviewed at (1.9 vs. 1.3; p < 0.01) and matched at (33.7% vs. 23.9%; p = 0.048) significantly more away rotation institutions than applicants with a HP. CONCLUSION: Applicants with NHP received fewer interviews and had lower match rates. Away rotations may be especially important for applicants with NHP. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

Association of Medical School Gap Year Research and Degree Programs With Otolaryngology Interview and Match Outcomes.

OBJECTIVE: To investigate whether a gap year for either research or a master's degree is associated with interview offers or match outcomes among otolaryngology applicants. METHODS: Using the Texas Seeking Transparency in Application to Residency (Texas STAR) database, we conducted a cross-sectional analysis of otolaryngology applicants from 2018 to 2022. Applicants were stratified based on the presence and type of gap year during medical school. Applicant characteristics, signaling, research productivity, and application costs were analyzed, with primary outcomes including number of interview offers and match status. RESULTS: Among 564 otolaryngology applicant respondents to the Texas STAR survey, 160 (28%) reported a gap year, including 64 (40%) applicants participating in a research year, 65 (41%) completing a Master of Public Health or Science (MPH and MSc), and 31 (19%) completing a Master of Business Administration, Education, or other degree (MBA and MEd). Gap-year applicants who completed a research year or MPH/MSc degree received more interview offers (P < .01) than MBA, MEd applicants, or those without a gap year. Applicants with a research year had the most publications, oral presentations, abstracts, posters, and research experiences (all P < .01). When controlling for USMLE scores, clerkship honors, and applications submitted, applicants completing a research year or an MPH/MSc-degree received increased interview offers (P < .01). No significant differences were seen in expenditures or match rates. CONCLUSIONS: Research and MPH/MSc gap years were associated with increased residency interview offers but not increased match success. Further longitudinal studies are needed to assess how yearlong experiences affect long-term career outcomes.

Predictors of Plastic Surgery Applicant Success: An Analysis of the Texas STAR Database.

INTRODUCTION: Integrated plastic surgery residency is one of the most competitive medical specialties. Although previous studies have surveyed integrated plastic surgery residency program directors regarding desired applicant characteristics, there is a paucity of literature assessing detailed application characteristics and reported match outcomes from applicants in recent application cycles. This study examines application characteristics associated with matching into integrated plastic surgery residency from 2017 to 2023. METHODS: The authors accessed the Texas Seeking Transparency in Application to Residency database, which contains survey information from graduating medical students nationwide regarding residency application characteristics and specialties/programs to which applications were submitted. Characteristics of matched versus unmatched applicants between 2017 and 2023 were compared using χ 2 and 2-sided, independent t tests. Univariate logistic regression models were used to assess predictors of a successful match. RESULTS: A total of 381 integrated plastic surgery residency applicants responded to the Texas Seeking Transparency in Application to Residency survey from 2017 to 2023. Mean United States Medical Licensing Exam Step 2 CK scores; the number of away rotations, interview offers, and honored clerkships; and Alpha Omega Alpha membership rate were significantly associated with and predictive of matching. Preference signaling of programs was associated with an increased interview offer rate. CONCLUSIONS: Higher board examination scores, increasing numbers of honored clerkships, away rotations, and Alpha Omega Alpha membership were identified as statistically significant predictors of matching into integrated plastic surgery residency. Prospective applicants should use this information to help guide their efforts in these areas that appear to be associated with a successful transition to residency.

Evaluating the Impact of the Novel Geographic Preferences Section on Interview Rate and Residency Match Outcomes.

BACKGROUND: The American Association of Medical Colleges trialed residency application initiatives including geographic preferences and preference signals in 2022. OBJECTIVE: To assess the impact of geographic preferences on application outcomes during the 2022 residency match year. DESIGN: Cross-sectional. PARTICIPANTS: Applicants to categorical and preliminary internal medicine during the 2022 application cycle who completed the Texas Seeking Transparency in Applications to Residency survey. MAIN MEASURES: The primary outcome was interview rate (interview offers/total applications) and whether an application resulted in a match. The key dependent variables were geographic preferences and program-specific preference signals. We also assessed differences in utilization of geographic preferences between specialties. KEY RESULTS: A total of 970 applicants into categorical (n = 884) and preliminary (n = 86) internal medicine were included in our study. A total of 704 (72.6%) applicants submitted at least one geographic preference and 424 (43.7%) submitted three preferences. On average, applicants who submitted a geographic preference had a higher interview rate than those who did not (46.0% vs. 41.8%). Applications submitted with both a preference signal and geographic preference were significantly more likely to receive an interview offer (OR: 3.2, p < 0.01) and match (OR: 6.4, p < 0.01) than applications with neither a preference signal nor a geographic preference. Geographic preferences were associated with an increase in the odds of an application receiving an interview offer, even in the setting of a preference signal (OR: 1.4, p < 0.01). CONCLUSIONS: Both preference signals and geographic preferences have significant associations with odds of an application receiving an interview and matching for both categorical and preliminary internal medicine applicants. This study can be used to inform applicants, advisors, and programs how novel application strategies can affect important application outcomes for US medical school graduates. As more specialties pilot alternative processes, it will be important to study all application outcomes among varying applicant populations.

Does Geographic Region of Away Rotations Predict Otolaryngology Match Outcomes?

OBJECTIVE: To assess whether the geographic region where medical students complete an away rotation predicts the same site, region-specific, or overall interview offers and match success in otolaryngology. STUDY DESIGN: Cross-sectional. SETTING: US medical schools. METHODS: We queried the Texas Seeking Transparency in Application to Residency database to analyze outcomes of otolaryngology applicants during the 2018 to 2020 and 2022 match cycles. Outcomes included a number of interviews offered, geographic location of interviews, and match results, including region-specific and overall match success rate. RESULTS: Of 455 otolaryngology applicants, 402 (90.3%) completed an away rotation. Among these, 368 (91.8%) were offered an interview and 124 (30.9%) matched to the program where they completed an away rotation. Applicants who completed away rotations outside their home region received more interview offers from that region than those who did not (Northeast: 4.2 vs 2.9; South: 4.3 vs 3.0; Central: 4.8 vs 3.0; West: 3.8 vs 1.6, P < .01 for all). Completing a remote away rotation increased the odds of receiving an interview from and matching within that region. After excluding programs where an away rotation was completed, a remote away rotation increased the odds of receiving an interview in the central and western regions (Central: odds ratio [OR]: 1.2 [1.1, 1.5]); West OR: 1.9 [1.7, 2.2]; and the odds of matching in the western region (OR: 2.9 [1.2, 7.4], all P < .01). CONCLUSION: Away rotations are associated with increased odds of interviewing and matching at that away program, with possible associations across the region, most evident for the West coast.

Impact of Applicants' Characteristics and Geographic Connections to Residency Programs on Preference Signaling Outcomes in the Match.

PURPOSE: To assess the impact of applicant and residency program characteristics on preference signaling outcomes in the Match during the first 2 years of implementation across 6 specialties. METHOD: Data were obtained from the Texas Seeking Transparency in Application to Residency survey for applicants applying into otolaryngology during the 2020-2021 and 2021-2022 application cycles and into dermatology, internal medicine (categorical and preliminary year), general surgery, and urology during the 2021-2022 application cycle. The primary outcome was signal yield, defined as the number of interviews at signaled programs divided by the total number of signals sent. Associations with applicant-reported characteristics and geographic connections to residency programs were assessed using Wilcoxon rank sum testing, Spearman's rank correlation testing, and ordinary least squares regression. RESULTS: 1,749 applicants with preference signaling data were included from internal medicine (n = 884), general surgery (n = 291), otolaryngology (n = 217), dermatology (n = 147), urology (n = 124), and internal medicine preliminary year (n = 86). On average 60.9% (standard deviation 32.3%) of signals resulted in an interview (signal yield). There was a stepwise increase in signal yield with the percentage of signals sent to programs with a geographic connection (57.3% for no signals vs. 68.9% for 5 signals, P < .01). Signal yield was positively associated with applicant characteristics, such as United States Medical Licensing Exam Step 1 and 2 scores, honors society membership, and number of publications ( P < .01). Applicants reporting a lower class rank quartile were significantly more likely to have a higher percentage of their interviews come from signaled programs ( P < .01). CONCLUSIONS: Signal yield is significantly associated with geographic connections to residency programs and applicant competitiveness based on traditional metrics. These findings can inform applicants, programs, and specialties as preference signaling grows.

Understanding the Match: The Effect of Signaling, Demographics, and Applicant Characteristics on Match Success in the Orthopaedic Residency Application Process.

INTRODUCTION: As of the 2022 to 2023 match cycle, orthopaedic residency programs began offering applicants 30 signals as part of a preference signaling program. Many have assumed that signals would become powerful tools in the match process, yet no objective data currently exist analyzing their effect. This study aims to provide such analysis while also offering comparisons with other factors affecting match success. METHODS: Self-reported survey data on applicants and applications from 2017 to 2023 from the Texas Seeking Transparency in Application to Residency database were queried. Variables associated with receiving interviews and match success were analyzed using two-sided Student t -tests, chi-squared tests, variance ratio testing, and receiver operating characteristic analysis. RESULTS: Compared with 2017 to 2022, 2023 applicants submitted fewer applications (61.8 versus 78; P < 0.001), received fewer interview offers (11.6 versus 13.8; P < 0.001), and interview offers were spread more evenly among applicants (SD, 6.82 versus 9.10; P < 0.001). For 2023 applications, odds of securing an interview were increased most by away rotations (odds ratios [OR] 61.8; P < 0.001), use of a signal (OR, 9.61; P < 0.001), and geographic connection (OR, 4.70; P < 0.001). Female applicants received more interview offers from signaled programs than their male counterparts (11.2 versus 8.94; P = 0.003). Applicant variables most predictive of match success in 2023 were interview offers (area under the receiver operating characteristic curve [AUC] = 0.802), step 2 CK score (AUC = 0.673), and step 1 score (AUC = 0.648). DISCUSSION: The preference signaling program seems to be accomplishing its goals of reducing applications and more evenly distributing interviews. Away rotations, signals, and geographic connections represent the strongest predictors of applications resulting in a successful match. Applicants must use their signals carefully to maximize their chance of success. LEVEL OF EVIDENCE: Level III.

Association of Virtual Away Rotations With Residency Applicant Outcomes in Otolaryngology.

Objective: To examine how virtual away rotations might influence interview and match outcomes in otolaryngology. Study Design: Cross-sectional retrospective analysis of survey-based study. Setting: United States medical students applying to otolaryngology residency in the 2020 to 2021 cycle. Methods: The Texas Seeking Transparency in Application to Residency database was queried to identify otolaryngology applicants during the 2020 to 2021 cycle. The primary outcome was mean number of interview offers. χ 2 tests, 2-sided t tests, logistic regression models, and ordinary least squares regression models were used to examine associations with virtual away rotations. Results: Among 115 otolaryngology applicants identified, 35 (30.4%) applicants reported completing 1 or more virtual away rotations. Applicants who completed at least 1 virtual away rotation received significantly more interview offers than their counterparts who did not participate in virtual away rotations (mean [SD], 14.9 [8.2] vs 11.6 [7.9]; P < .03). Each virtual away rotation completed was associated with an incremental increase of 2 additional interview offers (ß coefficient: 2.29 [95% confidence interval, CI: 0.8-3.7; P < .01]). Applicants who completed a virtual away rotation were more likely to receive an interview from that program (62.7% vs 16.8%, P < .01) and to match there (odds ratio 7.7 [95% CI: 2.7-21.7]; P < .01) when compared to applicants who had not done the away rotation. Participation in virtual away rotations was not associated with significant improvement in match success (82.9% vs 67.5%; P = .09). Conclusion: Virtual away rotations were associated with improved program-specific interview and match outcomes, as well as a higher overall number of interview offers.

Impact of applicant and program factors on preference signaling outcomes in otolaryngology.

Objectives: To assess the impact of applicant and program characteristics on preference signaling outcomes during the 2021 and 2022 application cycles in otolaryngology. Methods: The Texas Seeking Transparency in Applications to Residency survey was used for otolaryngology applicants during the 2021 and 2022 match years. The primary outcome of interest was signal yield, defined as the number of interviews at signaled programs divided by the total number of signals sent. Associations with applicant-reported characteristics, geographic connections to programs, and program reputation were assessed. Results: On average 59.5% of signals resulted in an interview (signal yield). There was a positive correlation between the number of signals sent to a program with a reported geographic connection and signal yield, with each additional signal resulting in a 3.4% increase in signal yield (p = .03). Signal yield was positively associated with number of publications (p < .001); number of abstracts, posters, and presentations (p = .04); and whether the applicant took a research year (p = .003). Applicants with higher USMLE Step 1 (p = .01) and Step 2 (p = .003) scores, publications (p = .03), volunteer (p = .008) and leadership (p = .001) experiences received a lower percentage of their total interviews from signaled programs whereas applicants from the 3rd (p < .001) and 4th (p = .03) cumulative class ranked quartiles received a higher percentage of their total interviews from signaled programs. Conclusions: Signal yield appears to have a significant association with geographic connections to programs and applicant competitiveness. This study may help applicants, advisors, and programs maximize the benefit of the preference signaling system.Levels of evidence: Level 4.

Matching into competitive surgical residencies: predictors of success.

Evidence-informed data may help students matching into competitive residency programs guide curricular activities, extracurricular activities, and residency career choices. We aimed to examine the characteristics of students applying to competitive surgical residencies and identify predictors of matching success. We identified the five lowest match rates for the surgical subspecialities listed in the 2020 National Resident Matching Program report to define a surgical residency as competitive. We analyzed a database from 115 United States medical schools regarding application data from 2017 to 2020. Multilevel logistic regression was used to determine predictors of matching. Statistical significance was set at p < 0.05.A total of 1,448 medical students submitted 25,549 applications. The five most competitive specialties included were plastic surgery (N = 172), otolaryngology (N = 342), neurological surgery (N = 163), vascular surgery (N = 52), orthopedic surgery (N = 679), and thoracic surgery (N = 40). We found that medical students with a geographical connection (adjusted OR, 1.65 [95% CI, 1.41 to 1.93]), and students who did an away rotation at the applied program (adjusted OR, 3.22 [95% CI, 2.75 to 3.78]) had statistically significantly increased odds of matching into a competitive surgical specialty. Furthermore, we found that students with a United States Medical Licensing Examination (USMLE) Step 1 score below 230 and Step 2 Clinical Knowledge (CK) score below 240 had increased odds of matching if they completed an away rotation at the applied program. Completing an away rotation and geographical connection to the institution may contribute more than academic criteria for selection into a competitive surgical residency after an interview. This finding may be due to less variation in academic criteria among this pool of high-performing medical students. Students with limited resources who apply to a competitive surgical specialty may be at a disadvantage given the financial burden of an away rotation.

The indelible marks on dermatology: Impacts of COVID-19 on dermatology residency Match using the Texas STAR database.

With changes to interview format and away rotations, the COVID-19 pandemic has reshaped the residency application process. In this retrospective cohort study of data from the nationwide Texas Seeking Transparency in Applications to Residency (STAR) survey, we sought to understand how the pandemic has affected applicants in the 2021 dermatology Match. We compared applicants in the post-COVID-19 Match year (2021) with those in pre-COVID-19 Match years (2018-2020) regarding match rates, interview costs, residency geographic connections, and number of interviews attended. A total of 439 dermatology applicants who completed the Texas STAR survey were included. There was no difference in percentage of applicants with a geographic connection to their matched program (43.88% vs 47.20%). Compared with prior cycles, applicants in the 2021 Match had a higher percentage of interview offers (96% vs 90%, P < .0001), and more applicants attended 16 or more interviews (P = .0489). Applicants in the 2021 Match reported an average savings of $5,000 compared with prior cycles. Virtual interviews offer savings for applicants but may encourage interview hoarding. Though applicants did not perform away rotations, there was no increase in geographic connection for matched applicants. Stakeholders should consider these data when evaluating the pros and cons of virtual interviewing postpandemic.

Cost of the Otolaryngology Residency Application Process: Comparison With Other Specialties and Equity Implications.

Objective: This study aims to assess trends in applicant-reported costs of the otolaryngology residency application process between 2019 and 2021 and evaluate the impact of application costs on number of interview offers. Study Design: Cross-sectional study. Setting: US allopathic and osteopathic medical schools. Methods: Survey data from applicants were obtained from the Texas STAR database (Seeking Transparency in Application to Residency) for the years 2019 to 2021. Outcomes included total cost, interview cost, other costs, application fees, and number of interview offers. Simple and multivariable linear regression was used to identify novel predictors of cost and assess the correlation between cost and interview offers. Results: Among 363 otolaryngology applicants, there was a 74% reduction in total costs and a 97% reduction in interview costs in the 2021 cycle vs the 2020 cycle. Significant predictors of total cost among otolaryngology applicants included the number of away rotations (P < .01), the number of research experiences (P = .04), and couples matching (P < .01). During the 2019 and 2020 application cycles, there was a significant association between applicant-reported total spending and number of otolaryngology interview offers (P < .01), which was not present during the 2021 cycle (P = .35). Conclusion: Number of otolaryngology interview offers appears to be directly correlated with applicant-reported total costs regardless of number of applications or interviews attended, which may be a source of inequality in the application process. There was a drastic reduction in total costs, interview costs, and other costs during the COVID-19 pandemic, which was likely driven by virtual interviewing and the absence of away rotations.

Effect of the COVID-19 pandemic on the residency match among surgical specialties.

BACKGROUND: Despite unprecedented changes to undergraduate medical education and the residency selection process during the COVID-19 pandemic, there is little objective evidence on how the pandemic affected match outcomes such as matched applicant characteristics, interview distribution, geographic clustering, and associated costs. We investigated COVID-19's impact on the residency match by comparing surgery applicants' characteristics, interview distribution, and related costs from 2018 to 2020 to 2021. METHODS: Data from the Texas Seeking Transparency in Applications to Residency initiative were analyzed. Descriptive statistics, bivariate testing, and sensitivity analysis were performed to compare matched applicants in surgical specialties from 2018-2020 to 2021. RESULTS: This study included 5,258 applicants who matched into 10 surgical specialties from 2018 to 2021. In 2021, there was a decrease in proportion of students who reported a geographic connection to their matched program (38.4% vs 42.1%; P = .021) and no significant difference in number of interviews attended (mean [SD], 13.1 [6.2] vs 13.3 [4.7]; P = .136) compared to prior years. Applicants in 2021 had more research experiences and fewer honored clerkships (both P < .001), and these associations persisted in sensitivity analysis. Matched applicants in 2021 reported significantly lower total costs associated with the residency application process compared to 2018 to 2020 (mean [SD] $1,959 [1,275] vs $6,756 [4,081]; P < .001). CONCLUSION: Although COVID-19 appeared to result in a reduction in number of honored clerkships, it may have provided more opportunities for students to engage in research. Overall, the adoption of virtual interviews and away rotations may have successfully mitigated some of the adverse consequences of the pandemic on the residency match for surgical specialties.

Evaluation of Predictors for Successful Residency Match in General Surgery.

OBJECTIVE: To determine predictive factors for a successful residency match among general surgery applicants from 2018 to 2021. DESIGN: A retrospective cross-sectional study of general surgery applicants who matched and went unmatched in match years 2018 to 2021. Applicant characteristics, geographic connections to a program, and away rotations were compared among matched and unmatched applicants. SETTING: Data were sourced from the Texas Seeking Transparency in Applications to Residency initiative for general surgery applicants. PARTICIPANTS: All fourth-year medical students applying in the 2018 to 2021 cycles at participating U.S. medical schools were eligible to respond to the Texas Seeking Transparency in Applications to Residency survey. This study included a total of 1,425 general surgery applicants. RESULTS: Of 1,425 general surgery applicants, 88% matched and 12% went unmatched. Significant predictors for a successful match included Step 1 Score ≥237 (odds ratio (OR) 1.59 [95% CI 1.15-2.19]; p = 0.005); Step 2 CK Score ≥252 (OR 1.88 [95% CI 1.36-2.60]; p < 0.001); ≥3 Honored Clerkships (OR 1.84 [95% CI 1.33-2.53]; p < 0.001); Honors in General Surgery Clerkship (OR 1.73 [95% CI 1.33-2.53]; p = 0.001); AOA membership (OR 2.14 [95% CI 1.34-3.42]; p = 0.001); ≥4 abstracts, posters, or publications (OR 1.66 [95% CI 1.20-2.30]; p=0.002); and ≥1 peer-reviewed publications (OR 1.52 [95% CI 1.09-2.12]; p = 0.014). On average, matched applicants completed more away rotations than unmatched applicants (p = 0.004). Overall, 36% of matched applicants reported a geographic connection to the program where they matched. CONCLUSIONS: We found that Step 2 CK score, research productivity, honored clerkships, AOA status, and away rotations are significant predictors for successfully matching into general surgery residency. Medical schools can encourage students to prepare a holistic application incorporating variables quantified in this study in preparation for the Step 1 reporting change.

Impact of the COVID-19 Pandemic on the 2021 Otolaryngology Residency Match: Analysis of the Texas STAR Database.

OBJECTIVES/HYPOTHESIS: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the 2021 otolaryngology match with regard to geographic clustering, interview distribution, applicant-reported costs, and matched applicant characteristics. STUDY DESIGN: Retrospective cohort study. METHODS: Survey data from applicants to otolaryngology residency programs were obtained from the Texas Seeking Transparency in Applications to Residency database. Applicant differences between the 2021 match year and prior match years (2018, 2019, and 2020) were analyzed using two-sided t-tests, Chi-square tests, and Fisher's exact tests. RESULTS: A total of 442 otolaryngology residency applicants responded to the survey, including 329 from the match years 2018 to 2020 and 113 from match year 2021. In 2021, 30.7% of responding applicants reported matching at a program where they had a geographic connection, compared to 40.0% in prior years (P = .139). Matched applicants in 2021 reported attending less interviews than applicants in prior years (mean 12.2 vs. 13.3, P = .040), and 26.1% of responding applicants reported matching at a program where they sent a preference signal. Applicants in the 2021 match reported significantly lower total costs than applicants in prior years (mean difference -$5,496, 95% confidence interval -$6,234 to -$4,759; P < .001). Compared to prior match years, matched applicants in 2021 had no meaningful differences in characteristics such as United States Medical Licensing Exam board scores, clerkship grades, honors society memberships, research output, volunteer experiences, or leadership experiences. CONCLUSION: Based on this sample, there was no evidence of significant interview hoarding or increased geographic clustering in the 2021 otolaryngology match, and the COVID-19 pandemic did not appear to result in significantly different matched applicant characteristics. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:1177-1183, 2022.

At-home medical student simulation: achieving knot-tying proficiency using video-based assessment.

Purpose: Due to the pandemic, we restructured our medical student knot-tying simulation to a virtual format. This study evaluated curriculum feasibility and effectiveness. Methods: Over 4 weeks, second-year medical students (n = 229) viewed a video tutorial (task demonstration, errors, scoring) and self-practiced to proficiency (no critical errors, < 2 min) using at-home suture kits (simple interrupted suture, instrument tie, penrose drain model). Optional virtual tutoring sessions were offered. Students submitted video performance for proficiency verification. Two sets of 14 videos were viewed by two surgeons until inter-rater reliability (IRR) was established. Students scoring "needs remediation" attended virtual remediation sessions. Non-parametric statistics were performed using RStudio. Results: All 229 medical students completed the curriculum within 1-4 h; 1.3% attended an optional tutorial. All videos were assessed: 4.8% "exceeds expectations", 60.7% "meets expectations", and 34.5% "needs remediation." All 79 needing remediation due to critical errors achieved proficiency during 1-h group sessions. IRR Cohen's κ was 0.69 (initial) and 1.0 (ultimate). Task completion time was 56 (47-68) s (median [IQR]); p < 0.01 between all pairs. Students rated the overall curriculum (79.2%) and overall curriculum and video tutorial effectiveness (92.7%) as "agree" or "strongly agree". No definitive preference emerged regarding virtual versus in-person formats; however, 80.2% affirmed wanting other at-home skills curricula. Comments supported home practice as lower stress; remediation students valued direct formative feedback. Conclusions: A completely virtual 1-month knot-tying simulation is feasible and effective in achieving proficiency using video-based assessment and as-needed remediation strategies for a large student class.

Predictors of otolaryngology applicant success using the Texas STAR database.

OBJECTIVES: To examine applicant characteristics and behaviors associated with a successful match into otolaryngology residency. METHODS: Self-reported survey data from applicants to otolaryngology residency between 2018 and 2020 were obtained from the Texas STAR database. Characteristics and predictors associated with a successful match were examined using Chi-square tests, two-sided t-tests, and logistic regression models. RESULTS: A total of 315 otolaryngology residency applicants responded to the survey of whom 274 matched (87%) and 41 did not match (13%). Matched applicants had a significantly higher mean USMLE Step 1 score (P = .016) and Step 2 CK score (P = .007). There were no significant differences in AOA status (45% vs 36%; P = .207), mean number of applications submitted (70 vs 69; P = .544), and mean number of away rotations (2.1 vs 2.0; P = .687) between matched and unmatched applicants. Significant predictors of a successful match included receiving honors in 5 or more clerkships (OR 2.0, 95% CI 1.0-4.0; P = .040), receiving honors in an ENT clerkship (OR 3.7, 95% CI 1.0-12.9; P = .044), and having 3 or more peer-reviewed publications (OR 2.3, 95% CI 1.1-4.5; P = .020). The majority of applicants (79.9%) matched at a program where they either did an away rotation, had a personal geographic connection, or attended medical school in the same geographic region. CONCLUSIONS: Board scores, excelling on clinical rotations, and having productive research experience appear to be strong predictors of a successful match in otolaryngology. The majority of applicants report a personal or geographic connection to the program at which they match. LEVEL OF EVIDENCE: 4.

Optimizing Medical Student Clerkship Schedules Using a Novel Application of the Hungarian Algorithm.

PROBLEM: Medical students often have preferences regarding the order of their clinical rotations, but assigning rotations fairly and efficiently can be challenging. To achieve a solution that optimizes assignments (i.e., maximizes student satisfaction), the authors present a novel application of the Hungarian algorithm, designed at the University of Texas Southwestern Medical Center (UTSW), to assign student schedules. APPROACH: Possible schedules were divided into distinct pathway options with k total number of seats. Each of n students submitted a ranked list of their top 5 pathway choices. An n × k matrix was formed, where the location (i, j) represented the cost associated with student i being placed in seat j. Progressively higher costs were assigned to students receiving less desired pathways. The Hungarian algorithm was then used to find the assignments that minimize total cost. The authors compared the performance of the Hungarian algorithm against 2 alternative algorithms (i.e., the rank and lottery algorithms). To evaluate the 3 algorithms, 4 simulations were conducted with different popularity weights for different pathways and were run across 1,000 trials. The algorithms were also compared using 3 years of UTSW student preference data for the classes of 2019, 2020, and 2021. OUTCOMES: In all 4 computer simulations, the Hungarian algorithm resulted in more students receiving 1 of their top 3 choices and fewer students receiving none of their preferences. Similarly, for UTSW student preference data, the Hungarian algorithm resulted in more students receiving 1 of their top 3 preferences and fewer students receiving none of their ranked preferences. NEXT STEPS: This approach may be broadly applied to scheduling challenges in undergraduate and graduate medical education. Furthermore, by manipulating cost values, additional constraints can be enforced (e.g., requiring certain seats to be filled, attempting to avoid schedules that begin with a student's desired specialty).