Improving information transparency between dermatology residency programs and trainees: Report from the Association of Professors of Dermatology Work Group on Transparency
Authors: Justin L. Jia, Zizi Yu, Surya A. Veerabagu, Nicole M. Burkemper, Adam J. Friedman, David Rosmarin, Jennifer T. Huang, Andrea T. Murina, Kristin M. Nord
Journal: Journal of the American Academy of Dermatology (2020)

To the Editor: Dermatology is among the most competitive residencies, with an 81.6% match rate for US allopathic seniors and the highest United States Medical Licensing Examination scores among specialties.1National Resident Matching ProgramCharting outcomes in the match: U.S. allopathic seniors. Characteristics of U.S. allopathic seniors who matched to their preferred specialty in the 2018 main residency match (2nd edition).https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2019/10/Charting-Outcomes-in-the-Match-2018_Seniors-1.pdfDate: 2018Date accessed: October 9, 2020Google Scholar To date, there has been limited literature assessing program-specific residency selection criteria and processes. Furthermore, the lack of accurate and complete program information may result in a poor fit between matched applicants and programs. The well-established lack of diversity in dermatology and the recent COVID-19 pandemic have prompted calls to rethink the resident selection process.2Pritchett E.N. Pandya A.G. Ferguson N.N. Hu S. Ortega-Loayza A.G. Lim H.W. Diversity in dermatology: roadmap for improvement.J Am Acad Dermatol. 2018; 79: 337-341Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar, 3Chen A. Shinkai K. Rethinking how we select dermatology applicants-turning the tide.JAMA Dermatol. 2017; 153: 259-260Crossref PubMed Scopus (53) Google Scholar, 4Stewart C.R. Chernoff K.A. Wildman H.F. Lipner S.R. Recommendations for medical student preparedness and equity for dermatology residency applications during the COVID-19 pandemic.J Am Acad Dermatol. 2020; 83: e225-e226Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 5Jones V.A. Clark K.A. Patel P.M. Cordova A. Tsoukas M.M. Considerations for underrepresented in medicine dermatology residency applicants amidst the COVID-19 pandemic.J Am Acad Dermatol. 2020; 83: e247-e248Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar We distributed a survey to prospective applicants, interns, dermatology residents, and program directors examining perceptions of and priorities in residency program transparency. We hypothesize that greater information transparency is needed between programs and applicants. In July 2020, a 19-item Qualtrics survey was administered to medical students, interns who matched into a dermatology residency, dermatology residents, and dermatology program directors through the Dermatology Interest Group Association, Dermatology in Review, and Association of Professors of Dermatology Program Directors' distribution lists. Statistical analyses were completed using SAS, version 9.4 (SAS Institute, Cary, NC). The Stanford University institutional review board deemed this study exempt. We received 490 completed responses: 69 program directors (75% response rate among program directors), 194 residents, 12 interns, and 215 medical students. There were no significant differences in responses among residents, medical students, and interns, so these were grouped as trainees for further analysis. Trainees were less likely than program directors to report that residency programs provide adequate transparency about the resident selection criteria and process (24.7% vs 39.1%; odds ratio, 0.51; 95% confidence interval, 0.30-0.87) and program-specific information (58.0% vs 72.5%; odds ratio, 0.52; 95% confidence interval, 0.30-0.92). Although program directors ranked emphasis on grades/honor society as similarly important to board cutoffs or requirements, trainees ranked the latter as more important (Table I). Trainees also prioritized interview slots, faculty/resident demographics and career interests, and rotation/call/consult/didactic schedules.Table ITrainees' and program directors' mean ranked importance in areas needing increased information transparency, mean (SD)∗Respondents were asked to rank how important (1, most important to 5, least important) it was to improve transparency in each information area. No 2 information areas were allowed the same rank.Information areaTrainees (dermatology residents, interns, medical students)(n = 421)Program directors(n = 69)Selection criteria (academics/research) Board score cutoffs or requirements1.69 (1.11)2.33 (1.48) Research requirements2.86 (1.10)3.44 (0.92) Emphasis on grades/honor society2.90 (1.05)2.30 (1.03) Letters of recommendation preferences or requirements2.97 (1.21)2.39 (1.20) Emphasis on advanced degrees4.59 (0.85)4.53 (0.78)Selection criteria (other considerations) Special consideration of certain applicant groups2.12 (1.09)2.32 (1.08) Emphasis on other elements of the application (leadership, volunteerism, personal interests)2.69 (1.10)2.83 (1.14) Emphasis on medical school3.07 (1.18)3.86 (1.07) Emphasis on holistic review3.32 (1.39)2.74 (1.53) Exclusion criteria (prior residency, IMG, DO)3.81 (1.62)3.26 (1.64)Logistics of selection process Number of interview slots vs number of resident slots2.24 (1.26)2.65 (1.23) Interview dates2.46 (1.41)1.87 (1.21) Format and number of interviews2.88 (1.16)2.76 (0.96) Etiquette for pre- or postinterview communication3.61 (1.27)4.16 (1.12) Resident involvement in selection process3.81 (1.25)3.56 (1.30)General information Current faculty/resident demographics and career interests2.03 (1.15)2.32 (1.09) Mission statement/program leadership2.94 (1.42)1.70 (1.06) Resident life: cost of living, places to live, things to do3.02 (1.32)3.56 (1.12) Diversity/inclusion statement and/or initiatives3.32 (1.39)3.14 (1.25) Psychosocial/wellness support3.69 (1.22)4.28 (0.85)Curricular/clinical program offerings Rotation/call/consult/didactic schedule2.17 (1.24)2.39 (1.12) Hospital location/patient population2.17 (1.28)1.76 (1.17) Subspecialty clinics2.97 (1.09)2.39 (1.12) Elective/research opportunities3.51 (1.12)3.65 (0.80) Fellowships available4.17 (1.17)4.71 (0.57)DO, doctor of osteopathic medicine; IMG, international medical graduate; SD, standard deviation.∗ Respondents were asked to rank how important (1, most important to 5, least important) it was to improve transparency in each information area. No 2 information areas were allowed the same rank. Open table in a new tab DO, doctor of osteopathic medicine; IMG, international medical graduate; SD, standard deviation. Of note, 84 (43.3%) residents stated that increased information transparency would have changed their rank lists (Table II). Rotation/call/consult/didactic schedule (38, 45.2%) followed by elective/research opportunities (31, 36.9%), psychosocial/wellness support (26, 31.0%), current faculty/resident demographics and career interests (26, 31.0%), and emphasis on medical school (26, 31.0%) were the most commonly reported topics that would have changed rank lists. Trainees most commonly accessed program-specific information through program websites (382, 90.7%). Finally, program directors' most frequently cited that the barrier to information transparency was due to lack of guidelines for what information should be shared (45, 65.2%).Table IIImpact of increased transparency on rank list, applicants' information sources, and program director–reported barriers to transparencyQuestionsn (%)Would increased transparency have changed your rank list? (n = 194 residents) Yes84 (43.3)Top 10 information areas that would have changed applicant rank lists (n = 84; residents who answered yes to the first question) Rotation/call/consult/didactic schedule38 (45.2) Elective/research opportunities31 (36.9) Emphasis on medical school26 (31.0) Psychosocial/wellness support26 (31.0) Current faculty/resident demographics and career interests26 (31.0) Board score cutoffs or requirements24 (28.6) Subspecialty clinics23 (27.4) Diversity/inclusion statement and/or initiatives21 (25.0) Fellowships available20 (23.8) Hospital location/patient population20 (23.8)Applicants' sources of program-specific information during the application cycle (n = 421 trainees) Programs' websites382 (90.7) Medical student/resident peers335 (79.6) Mentors260 (61.8) Google documents shared by students241 (57.2) Student Doctor Network152 (36.1) Association of American Medical Colleges website/Careers in Medicine159 (37.8) Doximity151 (35.9) Reddit145 (34.4) Programs' Instagram57 (13.5) Twitter44 (10.5) Programs' Facebook pages32 (7.6)Program director–reported barriers to information transparency (n = 69) Lack of guidelines for what information should be shared45 (65.2) Inability to quantify selection criteria36 (52.2) Lack of administrative support25 (36.2) Concerns about negative impact/perception22 (31.9) Lack of data15 (21.7) Departmental culture around transparency6 (8.7) None9 (13.0) Open table in a new tab In summary, both dermatology trainees and program directors believe there is inadequate program-specific transparency, with consensus regarding the relative importance of specific information areas. Greater transparency in selection criteria and programmatic offerings may improve trainees' experience and satisfaction with the match process. Standardized recommendations for program directors may improve awareness and ability to share program-specific information on program websites, which represent the primary source of information. Study limitations include potential response bias and difficulty assessing the strength of importance for individual topics using a ranking methodology. We were also unable to calculate the response rates for trainees. Nevertheless, our findings highlight the importance of improving transparency within the dermatology residency application process and providing guidance on specific information to prioritize.