APR 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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April 2013 EW NEWS & OPINION 13 Chief medical editor's corner of the world Finding future ophthalmologists: The match game O ne of the most difficult and yet important tasks for academic ophthalmology programs is the selection of residents. Outside of academia, all of us should have an interest in the process because it eventually determines who will become our professional peers and who will lead our specialty forward into the future. The good news is that ophthalmology continues to attract some of the top medical students, and the quality of the applicant pool continues to be strong. The fact that there are so many more qualified applicants than available positions makes this process especially difficult for most program directors. I was stunned to learn that the average applicant applies to 58 ophthalmology programs—more than half of the total number of ophthalmology programs in the country. Wow. Ayman Naseri, MD, is the residency program director at University of California, San Francisco (UCSF), and oversaw a large study on predictors of residency acceptance that is published this month in Ophthalmology. The study evaluated more than 3,400 applicants over a seven-year period and seems to confirm the importance of medical school reputation and quantitative criteria such as test scores. It was interesting to learn that the majority of applicants matched at a residency program from the same geographic region as their medical school. This month, I asked Dr. Naseri about the findings of this study, their significance, and about overall trends in the residency application pool and process. I also asked another residency director, EyeWorld editorial board member Steven Gedde, MD, to comment on the paper. David F. Chang, MD, chief medical editor Ayman Naseri, MD Dr. Chang: Is the overall number of U.S. ophthalmology residency applicants rising or falling? Dr. Naseri: In contrast to the rising number of medical school graduates, the number of applicants in ophthalmology has been falling fairly steadily since 1999. In fact, the data for the most recent match shows that we had a smaller number of applicants to ophthalmology in 2013 than in any year since the 1980s. Compared to the data from the 1999 match, there has been a 19% reduction in the number of applicants, despite an increase in the number of spots available. I do not intend to be an alarmist, but the trend may be concerning to some. It is odd that despite this trend, applicants feel compelled to apply to more and more programs. In fact, the average number of applications per applicant has gone from 38 in 2003 to 58 in 2013, an increase of more than 50%. Because of this, it may be that individual programs are seeing a similar number of applications to their specific program despite the decreasing number of total applicants to ophthalmology. I am hopeful that our study may shed some light on the match outcomes so that the process can become more efficient. Dr. Chang: What percentage of medical students wanting to enter ophthalmology gain acceptance into a U.S. residency? How difficult is this compared to other medical specialties? Dr. Naseri: If you look at all applicants together, the 2013 match rate was 67%, compared to a match rate in 1999 of 51%. If you separate U.S. medical students from foreign medical graduates, you would expect the match rates to be quite different. In our study reviewing the match outcomes between 2003 and 2008, the match rate for U.S. graduates was 72%, while the match rate for international graduates was 15%. Although it is difficult to do a direct "apples to apples" comparison, the match rate for ophthalmology appears similar to the match rates for radiology, orthopedic surgery, dermatology, and otolaryngology, based on National Residency Matching Program data. Ophthalmology is less competitive than continued on page 14 Comment on "Predictors of Matching in an Ophthalmology Residency Program" by Steven J. Gedde, MD, residency program director, Bascom Palmer Eye Institute, Miami O phthalmology is a highly competitive specialty with many more applicants than residency positions available. Ophthalmology match statistics (available at www.sfmatch.org) demonstrate that the match rate is much higher for senior students at U.S. medical schools relative to graduates of medical school and international medical graduates. The average USMLE Step 1 score among matched applicants has progressively increased from 224 in 2001 to 239 in 2013. This is an indicator that high quality individuals are continuing to enter ophthalmology training programs, which serves Steven Gedde, MD to ensure the future success of our profession. Loh and colleagues provide an excellent article that describes characteristics of U.S. medical students applying for ophthalmology residency and identifies predictors of success in matching. AOA membership, USMLE score, presence of an ophthalmology residency at medical school, a top rated medical school, and allopathic degree were significantly associated with matching in multivariate analysis. Applicants were more likely to match at a program in the same geographic region as their medical school, although a tendency for stronger applicants to match outside their geographic region was seen. These results are consistent with findings from a recent survey of ophthalmology program directors by Nallasamy and associates, which assessed factors involved in resident selection. Board scores, AOA status, and medical school attended are quantitative metrics that were strongly weighted in the process of selecting residents. However, performance on the interview and letters of recommendation are qualitative measures that were rated as being even more important. Unfortunately, the present study was unable to evaluate the influence of qualitative variables in residency selection. Additionally, the analysis was performed in the cohort of applicants who trained at medical schools in the U.S., and the results may not be generalizable to international students and graduates. The authors are to be congratulated for elucidating factors that improve an applicant's chance of successfully matching in ophthalmology. This information will prove valuable to applicants considering a career in ophthalmology and preparing for the match. It will also be beneficial for faculty who are advising medical students. References 1. Loh AR, Joseph D, Keenan JD, Lietman TM, Naseri A. Predictors of Matching in an Ophthalmology Residency Program. Ophthalmology. 2012 Dec 20 [Epub ahead of print]. 2. Nallasamy S, Uhler T, Nallasamy N, Tapino PJ, Volpe NJ. Ophthalmology Resident Selection: Current Trends in Selection Criteria and Improving the Process. Ophthalmology 2010;117(5):1041-7. Contact information Gedde: sgedde@med.miami.edu Dr. Naseri (right) attends a resident cataract operation by UCSF resident Dr. Michael Seider. Source: Ayman Naseri, MD

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