New education method or tool
Open Access

Piloting a Tool for Assessment of Person-organization Fit for Residency Applicants: Lessons from Organizational Psychology

William Rothstein[1], Alex Kremers[2], Stephanie Goldberg[1]

Institution: 1. Virginia Commonwealth University Health System, 2. Virginia Commonwealth University School of Medicine
Corresponding Author: Dr William Rothstein ([email protected])
Categories: Students/Trainees
Published Date: 06/11/2018

Abstract

The General Surgery residency application process has grown competitive, requiring medical students to apply to a greater number of programs.  While there has been much discussion of how programs can select the best applicants, there are few resources to help applicants.  Person-organization fit is an important determinant of job satisfaction, which itself is an important determinant of physician performance.  Using a validated method from the field Organizational Psychology, we developed a formal tool to assist residency applicants in assessing person-organization fit in prospective programs.

 

Keywords: Surgery; Styles; Medicine; Self-assessment; Mentoring

Introduction

In the 2018 General Surgery residency match, 1351 US seniors applied for 1319 positions, with 314 unsuccessful in securing a categorical position (National Residency Matching Program 2018).  Successful applicants ranked an average of 13.1 programs (National Resident Matching Program 2018). These figures suggest a competitive process, which is unlikely to remit as General Surgery positions grow slowly relative to other specialties (Hayek et al. 2018).  As applicants attend more interviews, the process of evaluating and ranking programs becomes more intimidating.  While numerous studies propose better methods for programs to evaluate candidates, there are few reciprocal tools for helping candidates evaluate programs (Bowe et al. 2017; Porter et al. 2017).  Matching applicants who are satisfied with their outcome is in the best interest of programs and hospitals, as physician satisfaction correlates with quality of care (Wallace et al. 2009)

 

The concepts of person-organization fit, defined as the congruence between the norms and values of organizations and the values of persons, been studied extensively in the fields of organizational psychology and management theory (Chatman 1989; O’Reilly et al. 1991; Scott et al. 2003).  A strong understanding of the interactions between organizational and individual value profiles can be useful in predicting what kinds of behaviors to expect over time (Chatman,1989).  Unfortunately for residency applicants, organizational culture can be difficult to define (Scott et al. 2003); what discreet factors define residency culture, and how can they be evaluated?

Methods and Results

We conducted a literature search for person-organization fit using multiple electronic databases available through our institutional subscriptions.  Key search terms included “person-organization fit”, “cultural fit”, and “cultural fit healthcare”.  In our review, we found a structured tool developed to help business students assess their fit at prospective firms by assessing organizational characteristics and weighting these by degree to which individuals valued these characteristics (O’Reilly et al. 1991).  The organizational values described were innovation and risk taking, attention to detail, orientation towards outcomes, aggressiveness, supportiveness, emphasis on growth, team orientation, and decisiveness.  Subjects rated prospective employers on these values and generated a composite person-organization fit score weighted by the personal importance of each value to the subject.  Subjects were then followed for the first year of their employment, with their person-organization fit score correlating with job satisfaction after regression analysis (O’Reilly et al. 1991).

 

Given the demonstrated validity of this method, we created an analogous tool tailored towards helping prospective residents judge their person-organization fit after interviews.  Our adapted key organizational characteristics were location, research activity, didactic curriculum, case mix/volume, resident autonomy, and camaraderie.  We organized this into an assessment tool that was provided to fourth year medical students entering the General Surgery match (see Appendices - Table 1.).   

 

Although the person-organization fit tool described by O’Reilly et al created a numerical score used to rank prospective organizations (O’Reilly et al. 1991), we elected to omit this element.  We believe that students will derive more benefit from the tool as a qualitative thought exercise than a numerical output.

We developed an additional questionnaire intended to streamline students’ evaluation process. These binary questions target key “make or break” features of residency programs:

 

  1. Can you see yourself as a resident in this program?
  2. Do you feel like the faculty you met could be your mentors?
  3. Do you think you would be happy in this program?
  4. Does this program have the appropriate resources to develop your clinical and research interests?
  5. Is this an environment in which you would feel comfortable challenging yourself?

Discussion

These tools were offered in parallel with formalized individual mentoring according to the best available peer-reviewed methods (Sng et al. 2017).  To our knowledge, this is the first described tool to formally apply validated organizational psychology methods to assist in the residency application process.  We believe that these resources will help our students navigate this complex process with improved clarity and satisfactory outcomes for both programs and applicants.  Furthermore, we believe this method to be generally applicable to residency applicants outside of General Surgery, and an important shift in recognizing the importance of supporting applicants and encouraging introspection to facilitate ideal person-organization fit.  

Take Home Messages

  1. There is a dearth of resources available to help residency applicants make structured decisions about ranking programs.
  2. Person-organization fit is a well-studied concept in organizational psychology that predicts job performance and satisfaction.
  3. Tools developed for business school students can be adapted to guide residency applicants in evaluating how well they fit in potential programs.

Notes On Contributors

William Rothstein is a General Surgery resident at Virginia Commonwealth University with an academic interest in medical education. 

 

Alex Kremers is a medical student at the Virginia Commonwealth University School of Medicine, currently applying to General Surgery through the NRMP.

 

Stephanie Goldberg is an Associate Professor of Surgery in the Division of Trauma and Acute Care Surgery at the Virginia Commonwealth University, with an academic interest in medical education and formal mentorship.

Acknowledgements

None.

Bibliography/References

Bowe SN, Laury AM, Gray ST. (2017). 'Improving Otolaryngology Residency Selection Using Principles from Personnel Psychology'. Otolaryngol Head Neck Surg. 156:981–984. https://doi.org/10.1177/0194599817698432

 

Chatman JA. (1989). 'Improving Interactional Organizational Research: A Model of Person-Organization Fit'. AMRO. 14:333–349. https://doi.org/10.5465/amr.1989.4279063

 

Hayek S, Lane S, Fluck M, Hunsinger M, et al. (2018). 'Ten Year Projections for US Residency Positions: Will There be Enough Positions to Accommodate the Growing Number of U.S. Medical School Graduates?' J Surg Educ. 75:546–551. https://doi.org/10.1016/j.jsurg.2017.08.021

 

National Residency Matching Program. (2018). National Resident Matching Program, Results and Data: 2018 Main Residency Match. National Resident Matching Program [Internet]. Available from: http://www.nrmp.org/wp-content/uploads/2018/04/Main-Match-Result-and-Data-2018.pdf

 

National Resident Matching Program. (2018). National Resident Matching Program, Charting outcomes in the Match: U.S. Allopathic Seniors. National Resident Matching Program [Internet]. Available from: http://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-Seniors.pdf

 

O’Reilly CA, Chatman J, Caldwell DF. (1991). 'People and Organizational Culture: A Profile Comparison Approach to Assessing Person-Organization Fit'. AMJ. 34:487–516. https://doi.org/10.5465/256404

 

Porter SE, Razi AE, Ramsey TB. (2017). 'Novel Strategies to Improve Resident Selection by Improving Cultural Fit: AOA Critical Issues'. J Bone Joint Surg Am. 99:e120. https://doi.org/10.2106/JBJS.17.00225

 

Scott T, Mannion R, Davies HTO, Marshall MN. (2003). 'Implementing culture change in health care: theory and practice'. Int J Qual Health Care. 15:111–118. https://doi.org/10.1093/intqhc/mzg021

 

Sng JH, Pei Y, Toh YP, Peh TY, et al. (2017). 'Mentoring relationships between senior physicians and junior doctors and/or medical students: A thematic review'. Med Teach. 39:866–875. https://doi.org/10.1080/0142159X.2017.1332360

 

Wallace JE, Lemaire JB, Ghali WA. (2009). 'Physician wellness: a missing quality indicator'. Lancet. 374:1714–1721. https://doi.org/10.1016/S0140-6736(09)61424-0

Appendices

Table 1. Residency program fit assessment tool

Program Factors

Importance of this factor

Program performance in this area

Location

Very important, somewhat important, unimportant

Great, good, average, poor

Research activity

Very important, somewhat important, unimportant

Great, good, average, poor

Didactic curriculum

Very important, somewhat important, unimportant

Great, good, average, poor

Case mix/volume

Very important, somewhat important, unimportant

Great, good, average, poor

Resident autonomy

Very important, somewhat important, unimportant

Great, good, average, poor

Camaraderie

Very important, somewhat important, unimportant

Great, good, average, poor

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

This manuscript does not involve human research subjects and does not require Ethics Approval.

External Funding

This paper has not had any External Funding

Reviews

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Ken Masters - (04/06/2019) Panel Member Icon
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An interesting paper detailing the development of Person-organisation fit tool to assist organisations and students applying for General surgery residency. The authors explain the problem of the need to get a good person-organisation fit, and the relevant literature background that has a bearing on the problem. After finding a suitable tool, the authors adapted for their purpose.

The tool looks interesting, but the authors have stopped short of their aim:
• They do not really give enough details about the tool is to be used, and
• They did not pilot it (as the title states), and so there is no real evaluation.

I think the tool may have some value, but the authors would really need to pilot it and perform some sort of evaluation before any kind of judgement can be made.
Possible Conflict of Interest:

For Transparency: I am an Associate Editor of MedEdPublish

P Ravi Shankar - (08/11/2018) Panel Member Icon
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The concept behind this paper is interesting. I agree with the authors that studying person-organization fit is important and it is a tool not currently offered to residency applicants. The authors provide a broad overview of how they developed their instrument based on the work of O’ Reilly and coworkers. The Appendix provides a description of the instrument. I am not sure about the process the residency applicants follow to obtain information regarding how the program performs in the different areas. The title mentions about piloting the tool but the paper does not mention anything about this. At present the information provided in the manuscript is about O’Reilly’s work and the parameters the authors considered while developing their instrument. I would also be interested in knowing about whether the authors were able to conduct a pilot test of their instrument.