Each year, graduating medical students in the United States (US) secure a residency position by participating in the National Residency Matching Program (NRMP). The NRMP match, also referred to as just “the match,” is becoming more and more competitive. Particularly competitive programs (e.g., plastic surgery) receive substantially more student applications than there are available residency positions. If a student fails to match to a residency position, then the student enters the Supplemental Offer Acceptance Program (SOAP). The SOAP is a less desirable means to secure a residency position for the following reasons: it occurs after the match and includes only those positions left unfilled in the US; not all specialities will have unfilled positions after the match; and most SOAP positions are only for one year preliminary programs, such as surgery and internal medicine. While completing a one year position will allow residents to apply for a medical license in the US, the limited one-year programs do not allow residents to become board certified in a medical specialty which would then force a student to re-enter the match again the following year.
Despite increasing numbers of available residency positions, hundreds of senior medical students have been unable to secure a position in the match and therefore have participated in the SOAP for the past several academic years (Greenberg, 2015). In general, students can no longer limit their number of interviews and expect to match in a US residency, particularly when applying to competitive specialties without a “back-up” or “parallel” plan, which requires students to apply to both preferred, competitive programs (e.g., neurosurgery) and to less competitive programs (e.g., family medicine) (Kirch, 2015). Academic advisors are encouraged to apply several resources to help students evaluate their competitiveness, such as the NRMP Charting Outcomes in the Match, the Results of Program Director Survey, and the Association of American Medical Colleges (AAMC) Careers in Medicine website (NRMP, 2014). These efforts and resources aim to maximize students’ ability to secure a residency program in the match.
Most US medical schools also have a committee that determines whether medical students are promoted to the next academic year. These committees also decide whether students should receive a probationary status or be dismissed from the program because of academic or professionalism deficiencies. Members of academic standards and promotion committees may be concerned whether promotion, probationary status, and remediation decisions made today will impact students’ career options for tomorrow. For example, earning a probationary status may prevent a student from being considered for a residency position. However, many educators also believe it is crucial to communicate honest information in academic records and in the medical student performance evaluations (MSPE), which is a summary of students’ academic progress that is necessarily sent to every residency program to which a student applies (Edmond et al, 1999). Some educators argue that it does no good to suppress negative information, which only serves to obfuscate the residency selection process. Indeed, guidelines give clear instructions on the content and organization of the MSPE, including information about whether a student was required to repeat any coursework or received an adverse action, such as probation (AAMC, 2016).
The purpose of this exploratory study was to examine factors that may be associated with students failing to match at two allopathic US medical schools: West Virginia University School of Medicine (WVU) and Michigan State University College of Human Medicine (MSU). Similarities and differences between the two schools’ match statistics may suggest how probationary histories reported on the MSPE and students’ ability to follow academic counsel may put students at risk for entering the SOAP.
The two schools use different approaches to evaluate students’ academic histories, which are reflected in the MSPE. While both WVU and MSU utilize an honors/pass/fail grading system, MSU also utilizes a “conditional pass” (CP) designation. A CP grade is the result of a student who has failed a specific component of a course. The student can remediate the failed component without repeating the entire course. Students who fail a course at WVU must repeat the entire course, regardless of which specific component or components fall below the passing standard.
Both WVU and MSU distinguish between academic and professionalism probation status, and report a student’s probation as an adverse action on the MSPE. The schools’ promotion and academic standards committees, however, have different interpretations of probation and consider different conditions that must occur before placing a student on probation. The Committee on Academic and Professionalism Standards (CAPS) at WVU places students on academic probation for failing any one of the required courses and clerkships in the curriculum, which is a strict interpretation of a probationary status. The student performance committee (SPC) at MSU has a different interpretation of academic probation. MSU implements an academic probation status when a student has academic issues beyond failing only one course. For example, if a student fails two courses or fails one course and earns a CP, then an academic probation status may be designated. Professionalism probation may also be designated on a student’s MSPE as an adverse action. The types of student behaviors and incidents that trigger a professionalism probation vary across circumstances. CAPS and SPC will place a student on professionalism probation if the behavior was egregious enough to warrant discipline and alert the student that any additional irregularities in professional behavior may lead to dismissal.
At both WVU and MSU, a probationary status requires students to meet with a faculty advisor who helps guide assigned students toward successful remediation. Most students who fail a course or clerkship successfully remediate and are subsequently removed from a probationary status. Students’ removal from probation is also reported in the MSPE. In addition, professionalism probation is often remediated as advisors collaborate with students to correct misconduct or unprofessional behavior.
WVU and MSU implement a robust career advising system. Both schools have multiple career advising events. Students are paired with an academic advisor to help prepare a residency application plan. There are two fundamental recommendations that are emphasized to both WVU and MSU students. Firstly, students who are applying to a competitive residency specialty should consider a parallel plan. That is, students should also apply to programs in a less-competitive specialty as a back-up plan. Considering an alternate specialty may be particularly necessary for students who did not perform well on national standardized examinations (e.g., United States Medical Licensing Step 1 examination). Secondly, students are advised to interview and rank at least eight or more residency programs. These recommendations are aimed at minimizing the number of students who initially fail to match. Students who enter the SOAP may have to abandon original specialty preferences and must select from only the available SOAP positions, the majority of which are one year preliminary programs. If students follow academic counsel and follow-through with a measured application plan, then they may be more likely to avoid the consequences of entering the SOAP.