Red Flags, Geography, Exam Scores, and Other Factors Used by Program Directors in Determining Which Applicants Are Offered an Interview for Anesthesiology Residency

Objective The goal of this study was to measure the most important factors in candidate applications that anesthesiology program directors (PDs) use to decide who to invite for an interview, and how that might change once the United States Medical Licensing Examination (USMLE) Step 1 is only reported as pass/fail. Design Based on a literature review, a comprehensive list of 27 factors used by PDs to select candidates for the interview was developed. An anonymous survey link was emailed to PDs of all Accreditation Council for Graduate Medical Education (ACGME) accredited Anesthesiology residencies. The survey asked PDs to rank order the top 10 factors they currently consider for making interview invitation, and then to repeat the rank ordering as if the USMLE Step 1 score was instead reported as pass/fail as will be done beginning in 2022. Results Forty-five of 159 (28%) PDs responded, with 82% disagreeing with changing the Step 1 score to pass/fail. 84% consider the Step 1 score (77% for Step 2) moderately or very important for selecting an applicant for an interview. The most frequently mentioned “red flags” were failure of a licensing exam, failure of a medical school course, gaps in education without explanation, and criminal history. 69% of PDs agreed that applicants coming from the medical school affiliated with their program would have an advantage over other applicants. Although, the three factors most commonly ranked in the top 10 in importance were the Step 1 score, followed by letters of recommendation, and then the Medical School Performance Evaluation, variability exists in how PDs ranked factors. For example, of the PDs that had Step 1 in the top 10, 27% had it ranked between the 6th and 10th most important. 9% of PDs did not have Step 1 score in the top 10. Core clinical clerkship grades were one of the top 5 factors by 49% of PDs, yet overall was the 6th most common top 10 factor as 36% of PDs did not have core clerkship grades at all in the top 10. Once Step 1 is reported only as pass/fail, PDs had letters of recommendation, Step 2, and the Medical School Performance Evaluation as the most frequently ranked factors in the top 10. 64% of the PDs supported restricting the number of programs a candidate can apply to, with the majority suggesting a limit of 15 to 20 programs per applicant. Conclusion Variability exists among anesthesiology PDs in the key criteria for offering an applicant an interview. Once Step 1 is reported as pass/fail, there will be an increased emphasis on Step 2 scores.