Vascular Surgery Integrated Resident Selection Criteria in the Step 1 Pass/Fail Era: A National Survey of Program Directors

Vascular surgery integrated residency (VSIR) programs are highly competitive; however, criteria for resident selection remain opaque and nonstandardized. The already unclear selection criteria will be further impacted by the impending transition of the United States Medical Licensing Examination (USMLE) step 1 from numeric scores to a binary pass/fail outcome. The purpose of this study is to investigate the historical and anticipated evaluation rubric of VSIR applicants. This is a cross-sectional, nationwide, 59-item survey that was sent to all VSIR Program Directors (PDs). Data were analyzed using the Fisher exact test if categorical and the Mann-Whitney U test and Kruskal-Wallis test if ordinal. Forty of 69 PDs (58%) responded to the survey. University-based programs constituted 85% of responders. The annual applicant number reviewed by most VSIR PDs ranged from 101 to 150 applicants (65%). Forty-two percent of the responding PDs reported sole responsibility for inviting applicants to interview, whereas 50% had a team of faculty responsible for applicant review. On a 5-point Likert scale, letters from vascular surgeons or colleagues were the most important objective criteria of selection (Table I), whereas work within a team structure was rated highest among subjective criteria (Table II). Majority of respondents (72%) currently use the step 1 score as a primary method to screen applicants. The current top ranked selection criteria are letters from a vascular surgeon, USMLE step 1 score, and overall letters of recommendation (LOR) (Fig 1). PDs responded that they will use the USMLE step 2 score (42%) and LOR (10%) to replace the USMLE step 1 score. The proposed top ranked selection criteria after transition of USMLE step 1 to pass/fail include LOR overall, step 2 score, and LOR from a vascular surgeon (Fig 2). This is the first study to evaluate the selection criteria used by PDs for VSIR. The landscape of VSIR selection criteria is shifting, and increasing transparency in this methodology is essential to applicants’ understanding of the selection process. LOR from vascular surgeons or colleagues of PDs are the most important factors during selection. Heretofore, the USMLE step 1 score was a first-line screening variable used by the majority of VSIR programs. The transition of USMLE step 1 to a pass/fail report will shift the attention to step 2 scores and elevate the importance of other variables. Deconstruction of the opaque VSIR evaluation methodology is a first step toward developing a holistic candidate evaluation methodology.Fig 2.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Table ILikert scale of objective selection criteriaFactorTotal (N = 40)StatisticsLetters from a vascular surgeon5.0 [4.0, 5.0]Letters from a colleague you know5.0 [4.0, 5.0]Letters of recommendation overall4.0 [4.0, 5.0]USMLE step 1 score4.0 [3.0, 4.0]USMLE step 2 score4.0 [3.0, 4.0]Medical school/elective rotations in vascular surgery4.0 [3.0, 4.0]Publication in a peer-reviewed journal4.0 [3.0, 4.0]Medical school grades3.5 [3.0, 4.0]Personal statement3.0 [3.0, 4.0]Research activity overall3.0 [3.0, 4.0]Research activity in vascular surgery3.0 [3.0, 4.0]Meeting abstract or poster presentation3.0 [3.0, 4.0]Reputation of medical school3.0 [2.0, 4.0]Medical school class rank3.0 [2.0, 4.0]Applicant completed a rotation in your program3.0 [2.0, 4.0]Dean’s letter3.0 [2.0, 4.0]MSPE3.0 [2.0, 4.0]AOA membership3.0 [2.0, 3.0]Extracurricular activities3.0 [2.0, 3.0]Reputation of undergraduate institution2.0 [2.0, 3.0]Advanced degree such as MBA, MPH, or similar2.0 [1.00, 2.0]Current general surgery resident1.00 [1.00, 2.0]Completed other residency program (eg, internal medicine, pathology, pediatrics)1.00 [1.00, 2.0]PhD degree1.00 [1.00, 2.0]AOA, American Osteopathic Association; MSPE, Medical Student Performance Evaluation; USMLE, United States Medical Licensing Examination.Likert scale of 5 points: extremely important—5 points, very important—4 points, important—3 points, somewhat important—2 points, and not important—1 point. Statistics presented as median [P25, P75]. Open table in a new tab Table IILikert scale subjective selection criteriaFactorTotal (N = 40)StatisticsAbility to work in a team5.0 [4.0, 5.0]Responses to interview questions4.0 [4.0, 4.5]Maturity4.0 [3.0, 4.5]General knowledge (excluding medical/vascular surgery)3.0 [3.0, 4.0]Questions that the candidate poses3.0 [3.0, 4.0]Overall appearance3.0 [2.0, 3.0]Attire3.0 [2.0, 3.0]Participation in SVS activities2.0 [1.5, 3.0]Age1.00 [1.00, 2.0]Family obligations1.00 [1.00, 2.0]Gender1.00 [1.00, 1.00]Apparent ethnicity1.00 [1.00, 1.00]SVS, Society for Vascular Surgery.Likert scale of 5 points: extremely important—5 points, very important—4 points, important—3 points, somewhat important—2 points, and not important—1 point. Statistics presented as median [P25, P75]. Open table in a new tab