Improving the Efficiency and Validity of the Selection Process for General Surgery Residency

Background: The application and interview process to match in general surgery is time- and labor-intensive. Different training programs seek to produce different types of graduates and therefore select different types of candidates. The goal of this thesis project is to improve the efficiency of the residency selection process by: 1) achieving consensus on the “ideal” general surgery applicant for our unique training program; and 2) developing a method to identify inaccuracies on the application. Methods: A modified Delphi survey was conducted with faculty surgeons and resident trainees at the University of Miami to determine the most highly valued characteristics. Three iterative rounds were conducted to identify and rank the importance of factors used for applicant ranking. Intraclass correlation was used to calculate level of agreement. Electronic Residency Application Service (ERAS) forms for all interview candidates were scrutinized by a medical librarian for the prevalence of inaccurate information. Inaccurate author order without applicant author promotion was not considered a “serious” inaccuracy. Results: Faculty and residents placed high value on USMLE Step 1, USMLE Step 2 CK, medical school grades, and letters of recommendation. Faculty also valued previous work history, leadership, and high-level achievement in an extracurricular activity, especially sports. Both groups value professionalism, personality, emotional intelligence, grit, work ethic, and the ability to work as a team. An excellent level of agreement was achieved. A total of 192 applicant ERAS forms were scrutinized for inaccuracies. After removing “non-serious” inaccuracies, there remained 25 (13% of 192) applicants with a serious inaccuracy, including author self-promotion, miscategorization, non-authorship of cited existing publication, and citation of a non-verifiable publication. Multiple logistic regression analysis did not reveal any demographic variables independently associated with any inaccuracy or a serious inaccuracy. Conclusions: An excellent level of agreement was achieved by an iterative group consensus technique to define the ideal general surgery residency applicant to our unique training institution. Nearly one in six (13%) applicants to general surgery residency training were found to have a “serious” inaccuracy in reporting their publications on the ERAS application.