Internal and geographic dermatology match trends in the age of COVID-19
Authors: Travis S. Dowdle, Michael P. Ryan, Richard F. Wagner
Journal: Journal of the American Academy of Dermatology (2021)

To the Editor: Matching into a dermatology residency program is an incredibly competitive process with many more highly qualified applicants than positions. Each year, a certain number of applicants end up matching to either their home institution's dermatology program or a program in a similar geographic region; however, the proportion of these matches has not yet been examined. There are numerous reasons why an applicant may favor their home program (Table I). In a typical year, most applicants complete 1 or more audition rotations across the country, where they spend 1 month working closely with, and developing relationships among, other dermatology departments and faculty. This past match cycle, due to the COVID-19 pandemic, recommendations were made advising against completing audition rotations and for interviews to be conducted virtually.1Specialty recommendations on away rotations for 2021-22 academic year. Association of American Medical Colleges.https://students-residents.aamc.org/applying-residency/article/specialty-response-covid-19/Date accessed: March 27, 2021Google Scholar Some audition rotation changes have persisted into the 2022 cycle.1Specialty recommendations on away rotations for 2021-22 academic year. Association of American Medical Colleges.https://students-residents.aamc.org/applying-residency/article/specialty-response-covid-19/Date accessed: March 27, 2021Google Scholar This investigation examined the proportion of dermatology applicants that historically matched to their home institution or geographic region and compared that to the trends during the most recent cycle affected by the COVID-19 pandemic.Table IAdvantages of matching home students to home programsPotential advantages for studentsPotential advantages for programsPre-existing (often multiyear long) relationships between faculty/applicantKnowledge of strengths and weaknesses of the program/applicantBetter ability to gauge the fit of the applicant within the departmentAbility for applicants to continue research with mentors in the departmentPotentially easier onboarding and less-intense adjustment period for incoming residentsMinimization of uncertainty and riskDesire to practice near residency program after graduationDesire to train physicians who may stay in the areaHome program may be more forgiving of application deficienciesKnown quality of medical students produced by home schoolMinimization of travel costs and moving hassles for the applicantFamiliarity with patient population and electronic health recordsProximity to social circle (family, friends, work, and spouse) Open table in a new tab Publicly available match lists were gathered from allopathic medical schools with associated dermatology residency training programs. Regions were established via the Association of American Medical College Residency explorer tool.2Residency explorer tool: dashboard.https://www.residencyexplorer.org/Home/DashboardDate accessed: March 27, 2021Google Scholar A 3-year control was established from 2018 to 2020 (70 schools) to establish baseline internal match and regional match percentages. This was compared to the 2020-2021 pandemic match (63 schools) using chi-square analysis in Excel (Microsoft). The results can be seen in Table II.Table IIInternal and regional match dataN/X (2018-2020)Prepandemic match % (2018-2020)N/X (2020-2021)COVID-19 match % (2020-2021)P valueInternal match171/64126.7%93/23140.3%∗A total of 4 programs either had 100% of open positions filled with internal candidates or 100% of fourth year medical students match into their home program. The 2 largest programs meeting these conditions both had 4 matches each.<.001†Significance is defined as P < .05 East53/19327.5%19/6031.7%.528 South67/22729.5%38/9042.2%.030∗A total of 4 programs either had 100% of open positions filled with internal candidates or 100% of fourth year medical students match into their home program. The 2 largest programs meeting these conditions both had 4 matches each. Central40/17423.0%28/6245.2%< .001†Significance is defined as P < .05 West10/4721.3%8/1942.1%.085Regional match394/63961.6%156/23167.5%.112 East131/19367.9%46/6076.6%.194 South124/22555.1%58/9064.4%.129 Central109/17462.6%41/6266.1%.624 West30/4763.8%11/1957.9%.652N, Raw number of internal matches; X, raw number of total matches.∗ A total of 4 programs either had 100% of open positions filled with internal candidates or 100% of fourth year medical students match into their home program. The 2 largest programs meeting these conditions both had 4 matches each.† Significance is defined as P < .05 Open table in a new tab N, Raw number of internal matches; X, raw number of total matches. In the prepandemic years, 26.7% of dermatology applicants matched to their home program, but during the most recent cycle that number jumped to 40.3% (P < .001), a relative increase of >50%. Despite the large and significant shift in internal matches, regional matches only had a slight, but statistically insignificant, increase from 61.6% to 67.5% (P = .11). Many factors likely played into this increase in internal matches, such as ongoing systematic changes in residency selection to promote diversity and equity and properly weighting objective measures of performance.3Luke J. Cornelius L. Lim H.W. Dermatology resident selection: shifting toward holistic review?.J Am Acad Dermatol. 2021; 84: 1208-1209Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar,4Change to pass/fail score reporting for Step 1. United States Medical Licensing Examination.https://www.usmle.org/announcements/?ContentId=290Google Scholar The largest factors may have been the lack of away rotations, lack of in-person interviews, and desire to minimize uncertainty. Away rotations are commonplace in dermatology and offer an inside look at how well of a fit an applicant and a program might be for each other. In-person interviews and preinterview dinners also play a similar role in gauging fit. These experiences often influence rank list decisions for both—applicants and programs.5Kolli S.S. Feldman S.R. Huang W.W. The dermatology residency application process.Dermatol Online J. 2021; 26: 13030PubMed Google Scholar In an unprecedented year with minimal audition rotations and in-person interviews, there was dramatically less exposure between applicants and programs, likely reducing the strength and confidence of programs and applicants to fully evaluate each other. The longstanding relationships between home students and their dermatology programs likely provided a level of certainty, familiarity, and safety, which allowed for risk minimization in a year otherwise filled with so many novelties. Further research should be aimed at determining which factors may have had the greatest impact on this uptick in internal matches and whether this trend was present in other highly selective fields that value away rotations. None disclosed.