Thursday, August 18, 2016

Audition electives, applying to programs, and interviewing

By now most rising fourth-year medical students have chosen a specialty and are busy preparing residency applications. A paper from October of last year in Academic Medicine sheds some light on the process.

Researchers from Mass General and the University of Vermont surveyed 2884 fourth-year students from 20 US medical schools in 2014; 1367 (47.4%) responded—52% of them were female.

Just over half of the students applied to internal medicine, pediatrics, or surgery residencies.

While the average number of programs applied to was 36.4, those seeking surgery applied to a mean of 58.2 programs, significantly more (p < 0.001) than those applying to any other specialty.

Except for radiology, for which applicants averaged 16.9 interviews, all other specialties including surgery had a mean of about 12 interviews per applicant.

Of those who answered the survey, only 71 (5.2%) did not match in the specialty they wanted.

The cost of interviewing was between $1000 and $5000 for about two thirds of the respondents with 14% spending less than $1000 and about 20% spending more than $5000.

The study produced some interesting data about fourth-year electives outside of the students’ medical schools, also known as “audition electives,” which were done by 56% of those surveyed. The mean number of audition electives was 1.8, with surgery and emergency medicine applicants significantly more likely to have done them, p < 0.001.

Audition electives influenced the ranking of programs for 89% of the students, but only 34% of them matched to programs where they had done an away elective.

Contrast that 34% match rate with this—81.8% of the survey respondents who did an audition elective felt that it would increase their chances of matching at that residency program. Apparently many of them were wrong.

Was the 34% match rate due to the students not finding the audition elective programs to their liking? Or were the programs not impressed with two-thirds of the students who did audition electives? Unfortunately, the paper was not able to investigate those questions.

The cost of doing an audition elective ranged from under $1000 for 42.1% of the applicants, $1000 to $3000 for 39.6%, and more than $3000 for 18.3%.

Another recent study found 71% of students applying to all specialties who auditioned “matched at one of their top three choices compared with 84% of non-auditioners who matched to one of their top three choices (p < 0.01).” Of 33 who did audition electives in general surgery, 1 (3%) matched at the hospital where the elective was done.

I receive many emails from medical students asking how they can improve their chances of matching in a surgical residency. They often mention audition electives. My standard answer has always been that I never put much stock in them because I feel it is easy for someone to be a superstar for a month or six weeks, but that doesn’t always translate into an excellent performance over one year or five years. I always told students who wanted to do audition electives with me that they should not have any misconceptions about the experience.

A post I wrote in 2014 about how surgery program directors choose applicants to interview cited a paper which found that a previous rotation at the PD’s institution ranked near the bottom of the selection criteria.

So do an away elective if you want to see how others do things or to learn something different, but don’t waste a lot of money and don’t expect it to guarantee you will match there.


Anonymous said...

This is drmuchogusto, twitter. I did 2 yrs of research with a great ENT program many yrs back. I observed two interview processes, who they selected, why they selected that candidate. The specific program I worked for choose mainly students that completed an audition rotation. However, not everyone who was not from the home school was scheduled for an audition rotation upon request. So they had 2 screening processes: once to be selected even to rotate and second when you applied. By then they had a really nice idea who they wanted. I do believe ENT and other specialized surgical residencies do value audition rotations. The competition for these programs is extremely high as they take 2 per yr. Another program I can think of is the integrative plastic program starting at pgy1. My experience in gen surg is that audition rotations have very little value. I did see also very ambitious students who completed an audition rotation with the ENT program I was doing research with that had borderline or low scores. They either were invited because someone wanted a favor or called. I never saw those candidates selected. I think the goal was to help them get in elsewhere, but I think they all went into other specialties. If you are applying gen surg, I feel someone vouching for you that is a familiar face in the surgical community goes a long way, but again I just do not place a lot of value in the audition rotation. If we are talking non-surg. If you are an MS who loves a particular medicine program and you are either borderline candidate or just want to lock in your spot, I do think sub-I for medicine can help a lot. Sub-I is not required by most schools. Completing a medicine sub-I can also help with your application to other programs. With the assumption you are working hard! Good luck!!

Skeptical Scalpel said...

Mucho, thanks for your observations. You may be right about the subspecialties, but I think that some program directors value audition electives more highly than others.

Unfortunately it's impossible to find out which programs consider them highly and which don't.

Anonymous said...

This is DrMuchoGusto, twitter. I agree! Another point I would like to make. Majority of the students who completed an audition rotation in the ENT dept I worked for they all had top scores. Majority of them were hard working too. So the people in charge mostly looked at the chemistry they had with the MS, whether this student would fit in as a team member. I feel they often choose people who were comfortable being a leader and follower. How down to earth the MS was. This program had advantage of being selective. Really, you know DR SS knowledge as a MS4 is so limited and so hard to judge. Really, when you have hard working MS and you see they earned nice scores, at that point all you can see who you want to work with the next few yrs. Yes, work ethic is a factor but I feel everyone coming in that is being considered has this. So the reason I am describing this because from a MS point of view I am sure they are thinking oh did the MS read all of schwartz or whatever the ENT book to read is and able to discuss it, I do not think that is the case at all. All the best in the match to those applying this yr!

Anonymous said...

Is a radiology residency easy to get into now days? And if so...why?

Skeptical Scalpel said...

Although this post is a year old, I think it is still valid

I can seem to get the NRMP website to open this morning, but if you go to it and look at the 2016 match results for radiology, it might help.

Also, it may depend on whether you are a graduate of a US med school or not.

Anonymous said...

I wonder if perhaps students who are less "competitive" are doing more audition rotations in general surgery to prove their mettle?
I did two because I wanted to see what large academic institutions were like compared to my own community-based medical school. I was never under any misconceptions that they would take me, or that I would even like them. It's difficult to figure out how to evaluate programs, and doing AIs helped me see what I wanted in a program and how other places could be different from my own training. So I would say they can be really good for students to figure out the type of residency they would like and what kind of dynamic they want.
With that being said, one of the places I did an AI I didn't love and won't be interviewing at, and the second is my top choice as of right now, so let's hope the percentages work out in my favor!

Skeptical Scalpel said...

You make some good points. I think you approached the audition elective with the right attitude. I am concerned that others may think the it will help them match. I wrote the post as a caution to those individuals.

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