Does "Hoarding" Impact Interview Distribution Among Orthopaedic Surgery Residency Applicants? A Modeling Study Based on a Large Database.

BACKGROUND: "Interview hoarding" is commonly used to refer to the concentration of interview offers among a small number of high-performing residency applicants. Theoretically, if the same applicants interview at every program, fewer rank lists will be submitted than open residency positions, leading to a "match crisis" with unfilled positions after the match. There are no published studies we are aware of that describe the observed distribution of residency interview offers among orthopaedic surgery applicants or the potential impact of "hoarding" on that distribution. QUESTIONS/PURPOSES: We examined the distribution of interview invitations extended to orthopaedic surgery residency applicants in the 2020 to 2021 and 2021 to 2022 application cycles. The change in the shape of the interview invitation distribution was the primary outcome for two central questions: (1) Does the interview offer distribution curve among orthopaedic surgery applicants change meaningfully from baseline with implementation of an interview cap (Model 1)? (2) What is the impact on the distribution of invitations with a reduction in the number of applicants in the field (Model 2)? METHODS: This was a retrospective study of orthopaedic surgery interview invitations extended to applicants via the Thalamus interview management program during the 2020 to 2021 and 2021 to 2022 residency application cycles. The Thalamus database was chosen because it contains data on interview invitations for orthopaedic surgery residency positions and has the largest market share in orthopaedics compared with similar databases. Thalamus data represent 1565 applicants and 53 residency programs (90% and 25% of the national total, respectively) in 2021 to 2022 and 993 applicants and 46 programs (77% and 23%, respectively) in 2020 to 2021. It has been shown to contain a representative sample of orthopaedic residency programs. An interview cap (Model 1) was simulated by removing excess interviews held by applicants above the 75th and 95th percentiles, which were chosen to represent a formal cap and an informal cap, respectively. A reduction in the size of the applicant pool was similarly modeled by randomly removing 5% and 25% of applicants, chosen to simulate informal and formal application requirements, respectively. In both models, the excess interviews were redistributed among the remaining applicants. RESULTS: Applicants received a mean of 1.8 ± 2.2 Thalamus interview invitations in 2020 to 2021 and 1.7 ± 2.4 invitations in 2021 to 2022, with no change to the overall distribution curve. A total of 39% (606 of 1565) of applicants received no Thalamus interview invitations in 2021 to 2022, 75% (1176 of 1565) received two or fewer, and < 1% (14 of 1565) of applicants received 10 or more invitations. Redistributing excess interviews held by the top 5% of applicants resulted in 2% (61 of 2651) of interviews being redistributed (Model 1). Removing 5% of the total applicant pool resulted in a redistribution of 3% (87 of 2651) of the interview invitations (Model 2). CONCLUSION: Orthopaedic surgery interview data demonstrated an expected uneven distribution of interview invitations, with a small proportion of highly competitive applicants receiving a higher number of interview offers as well as a large group of applicants receiving no interview invitations in Thalamus. Concerns that "hoarding" would lead to a crisis resulting in many unmatched residency positions seemed unfounded, given the excess of applicants relative to positions and the minimal change in the distribution of interviews in the cap model. CLINICAL RELEVANCE: Medical students applying to orthopaedic residency should seek individual advising to improve their individual odds of matching, while understanding that interview hoarding does not seem to alter the distribution of interviews. Program directors and medical students' advisors should be cognizant that a small proportion of applicants are broadly interviewed and may benefit from steps taken to ensure applicants have genuine interest in the program.

Over-Application and Interviewing in the 2021 United States Primary Care Virtual Recruitment Season.

Importance Over-application and interviewing are believed to be widespread in residency recruitment. These may have increased during the 2021 virtual recruitment season. The increase does not correspond to an increase in available residency positions and likely results in more interviews with low probabilities of yielding matches. Prior work demonstrates that such marginal interviews are identifiable ­ from key explanatory factors like same-state for interviewee and program ­ in sufficient volume to allow programs to substantially decrease interviews. Objective To evaluate the importance of same-state relationships in primary care and to determine the extent of over-interviewing in the 2021 virtual recruitment season. Design The National Resident Matching Program and Thalamus merged match (outcomes) and interview (explanatory variables) data from primary care specialties (family medicine, internal medicine, pediatrics). Data were analyzed by logistic regression, trained on the 2017-2020 seasons, and projected on the 2021 season for testing. Setting The setting was the 2017-2021 main residency matches. Participants This comprised 4,442 interviewees applying to 167 residency programs in primary care. Intervention This included the transition to virtual recruitment from in-person recruitment in the 2021 residency recruitment season. Measurements A total of 20,415 interviews and 20,791 preferred programs with program and interviewee characteristics and match outcomes were included. Results Same-state geographic relations predicted match probability in primary care residency interviews better than medical school/residency affiliation, with 86.0% of interviewees matching consistently with their preferences for the same state. Same-state was more effective than medical school affiliations with programs in predicting matching. Eliminating interviews with less than a 5% probability of matching (upper 95% prediction limit) removed 31.5% of interviews. Conclusions and relevance The large number of low-match probability interviews demonstrates over-interviewing in primary care. We suggest that programs eliminate interview offers to applications falling below their chosen match probability threshold.

Early vs Single Match in the Transition to Residency: Analysis Using NRMP Data From 2014 to 2021.

Background: An Early Result Acceptance Program (ERAP) has been proposed for obstetrics and gynecology (OB/GYN) to address challenges in the transition to residency. However, there are no available data-driven analyses on the effects of ERAP on the residency transition. Objective: We used National Resident Matching Program (NRMP) data to simulate the outcomes of ERAP and compare those to what occurred in the Match historically. Methods: We simulated ERAP outcomes in OB/GYN, using the de-identified applicant and program rank order lists from 2014 to 2021, and compared them to the actual NRMP Match outcomes. We report outcomes and sensitivity analyses and consider likely behavioral adaptations. Results: Fourteen percent of applicants receive a less preferred match under ERAP, while only 8% of applicants receive a more preferred match. Less preferred matches disproportionately affect DOs and international medical graduates (IMGs) compared to US MD seniors. Forty-one percent of programs fill with more preferred sets of applicants, while 24% fill with less preferred sets of applicants. Twelve percent of applicants and 52% of programs are in mutually dissatisfied applicant-program pairs (a pair in which both prefer each other to the match each received). Seventy percent of applicants who receive less preferred matches are part of a mutually dissatisfied pair. In 75% of programs with more preferred outcomes, at least one assigned applicant is part of a mutually dissatisfied pair. Conclusions: In this simulation, ERAP fills most OB/GYN positions, but many applicants and programs receive less preferred matches, and disparities increase for DOs and IMGs. ERAP creates mutually dissatisfied applicant-program pairs and problems for mixed-specialty couples, which provides incentives for gamesmanship.

Orthopaedic Surgery Residency Program Adherence to Universal Interview Offer Day Guidelines: A Retrospective Analysis.

INTRODUCTION: The 2020 to 2021 application cycle was marked by structural changes due to the COVID-19 pandemic. Adaptations included the American Orthopaedic Association Council of Residency Program Directors recommendations for a universal interview offer day (UIOD), synchronizing applicant interview offer release. As a novel process within orthopaedics, there are limited data on the execution and effect of a UIOD. Study goals include determining (1) residency program adherence to the Council of Residency Program Directors UIOD guidelines during the 2020 to 2021 cycle, (2) how quickly programs filled available interviews, and (3) any difference in time from release to booking between applicants using edu and com e-mail domains. METHODS: Orthopaedic residency programs and applicants using the Thalamus interview management software platform during the 2020 to 2021 residency application cycle were analyzed, representing 46 residency programs and 993 interviewees (22% and 77% of the national total, respectively). RESULTS: Of the programs included in this study, 19 (41%) were strictly adherent to the UIOD and time, 14 (30%) were weakly adherent and sent out offers outside of the assigned time, and 13 (28%) were nonadherent and sent out offers on dates other than the UIOD. The average time to fill to 80% capacity was 26 ± 14 minutes (range 3 to 77 minutes) for the 33 programs that released on the UIOD. Applicants with edu e-mail domains scheduled their first interview an average of 1.8 minutes after those with com e-mail domains (14.8 versus 13.0 minutes, P < 0.05). CONCLUSION: Despite more than 60% of the residency programs committing to participate, less than half of the programs that initially agreed to participate were strictly adherent to guidelines during the first UIOD in orthopaedic surgery. Although additional research is needed to analyze the unique, fully virtual 2020 to 2021 recruitment season, a phased or waved approach to the UIOD may improve the process for all stakeholders in future cycles. LEVEL OF EVIDENCE: Level V.

Reducing Over-Interviewing in the Anesthesiology Residency Match.

Background The U.S. residency recruitment process is expensive and time-consuming because of application inflation and over-invitation. Objective Using interview and match data, we quantify the predicted effects if anesthesiology residency programs excluded interviews for applicants who are very unlikely to match. Methods We previously published the validity and accuracy of the logistic regression model based on data from interview scheduling software used by 32 U.S. anesthesiology residency programs and 1300 applicants from 2015-18. Data used were program region, applicant address, numbers of interviews of the interviewee, medical school US News and World Report (USNWR) rank, the difference between United States Medical Licensing Exam (USMLE) Step 1 and 2 Clinical Knowledge (CK) scores, and the historical average of USMLE scores of program residents. In the current study completed in 2020, the predicted probabilities and their variances were summed among interviewees for 30 deidentified programs. Results For anesthesiology, the median residency program could reduce their interviews by 16.9% (97.5% confidence interval 8.5%-24.1%) supposing they would not invite applicants if the 99% upper prediction limit for the probability of matching was less than 10.0%. The corresponding median savings would be 0.80 interviews per matched spot (0.34-1.33). In doing so, the median program would sustain a risk of 5.3% (97.5% confidence interval 2.3%-7.9%) of having at least one interviewee removed from their final rank-to-match list. Conclusion Using novel interview data and analyses, we demonstrate that residency programs can substantively reduce interviews with less effect on rank-to-match lists. The data-driven approach to manage marginal interviews allows program leadership to better weigh costs and benefits when composing their annual list of interviewees.

Interview Data Highlight Importance of "Same-State" on Anesthesiology Residency Match.

BACKGROUND: The US residency application, interview, and match processes are costly and time-intensive. We sought to quantify the importance of an applicant being from the same-state as a residency program in terms of how this impacted the number of interviews needed to match. METHODS: We examined data from interview scheduling software used by 32 programs located in 31 US states and 1300 applicants for the US anesthesiology recruitment cycles from 2015 to 2018. Interviewee data (distance from program, region, numbers of interviews, and program at which interview occurred) were analyzed to quantify the effect of the interviewee being from the same state as the residency program on the odds of matching to that program. Other variables of interest (medical school, current address, US Medical Licensing Exam [USMLE] Step 1 and 2 clinical knowledge [CK] scores, Alpha Omega Alpha [AOA] status, medical school ranking) were also examined as controls. Confidence intervals (CI) were calculated for the ratios of odds ratios. RESULTS: An interviewee living in the same state as the interviewing program could have 5.42 fewer total interviews (97.5% CI, 3.02-7.81) while having the same odds of matching. The same state effect had an equivalent value as an approximately 4.14 USMLE points-difference from the program's mean (97.5% CI was 2.34-5.94 USMLE points). Addition of whether the interviewee belonged to an affiliated medical school did not significantly improve the model; same-state remained significant (P < .0001) while affiliated medical school was not (P = .40). CONCLUSIONS: Our analysis of anesthesiology residency recruitment using previously unstudied interview data shows that same-state locality is a viable predictor of residency matching and should be strongly considered when evaluating whether to interview an applicant.

Telemedicine in Leading US Neurology Departments.

OBJECTIVE: To determine the current practice and plans for telemedicine at leading US neurology departments. DESIGN AND SETTING: An electronic survey was sent to department chairs, administrators, or faculty involved in telemedicine at 47 neurology departments representing the top 50 hospitals as ranked by U.S. News and World Report. MAIN OUTCOME MEASURES: Current use, size, scope, reimbursement, and perceived quality of telemedicine services. RESULTS: A total of 32 individuals from 30 departments responded (64% response rate). The primary respondents were neurology faculty (66%) and department chairs (22%). Of the responding departments, 60% (18 of 30) currently provide telemedicine and most (n = 12) had initiated services within the last 2 years. Two thirds of those not providing telemedicine plan to do so within a year. Departments provide services to patients in state, out of state, and internationally, but only 6 departments had more than 50 consultations in the last year. The principal applications were stroke (n = 14), movement disorders (n = 4), and neurocritical care (n = 3). Most departments (n = 12) received external funding for telemedicine services, but few departments (n = 3) received payment from insurers (eg, Medicare, Medicaid). Reimbursement (n = 21) was the most frequently identified barrier to implementing telemedicine services. The majority of respondents (n = 20) find telemedicine to be equivalent to in-person care. CONCLUSIONS: Over 85% of leading US neurology departments currently use or plan to implement telemedicine within the next year. Addressing reimbursement may allow for its broader application.

Increasing access to specialty care: a pilot, randomized controlled trial of telemedicine for Parkinson's disease.

We conducted a randomized, controlled pilot trial to evaluate the feasibility of providing subspecialty care via telemedicine for patients with Parkinson's disease residing in a remote community located approximately 130 miles from an academic movement disorders clinic. Study participants were randomized to receive telemedicine care with a movement disorder specialist at the University of Rochester or to receive their usual care. Participants in the telemedicine group received three telemedicine visits over six months. Feasibility, as measured by the completion of telemedicine visits, was the primary outcome measure. Secondary measures were quality of life, patient satisfaction, and clinical outcomes. Ten participants residing in the community were randomized to receive telemedicine care (n = 6) or their usual care (n = 4). Four nursing home patients were assigned to telemedicine. Those receiving telemedicine completed 97% (29 of 30) of their telemedicine visits as scheduled. At the study's conclusion, 13 of 14 study participants opted to receive specialty care via telemedicine. Compared with usual care, those randomized to telemedicine had significant improvements in quality of life (3.4 point improvement vs. 10.3 point worsening on the Parkinson's Disease Questionnaire 39; P = 0.04) and motor performance (0.3 point improvement vs. 6.5 point worsening on the Unified Parkinson's Disease Rating Scale, motor subscale; P = 0.03). Relative to baseline, nursing home patients experienced trends toward improvement in quality of life and patient satisfaction. Providing subspecialty care via telemedicine for individuals with Parkinson's disease living remotely is feasible.

Funding of US biomedical research, 2003-2008.

CONTEXT: With the exception of the American Recovery and Reinvestment Act, funding support for biomedical research in the United States has slowed after a decade of doubling. However, the extent and scope of slowing are largely unknown. OBJECTIVE: To quantify funding of biomedical research in the United States from 2003 to 2008. DESIGN: Publicly available data were used to quantify funding from government (federal, state, and local), private, and industry sources. Regression models were used to compare financial trends between 1994-2003 and 2003-2007. The numbers of new drug and device approvals by the US Food and Drug Administration over the same period were also evaluated. MAIN OUTCOME MEASURES: Funding and growth rates by source; numbers of US Food and Drug Administration approvals. RESULTS: Biomedical research funding increased from $75.5 billion in 2003 to $101.1 billion in 2007. In 2008, funding from the National Institutes of Health and industry totaled $88.8 billion. In 2007, funding from these sources, adjusted for inflation, was $90.2 billion. Adjusted for inflation, funding from 2003 to 2007 increased by 14%, for a compound annual growth rate of 3.4%. By comparison, funding from 1994 to 2003 increased at an annual rate of 7.8% (P < .001). In 2007, industry (58%) was the largest funder, followed by the federal government (33%). Modest increase in funding was not accompanied by an increase in approvals for drugs or devices. In 2007, the United States spent an estimated 4.5% of its total health expenditures on biomedical research and 0.1% on health services research. CONCLUSION: After a decade of doubling, the rate of increase in biomedical research funding slowed from 2003 to 2007, and after adjustment for inflation, the absolute level of funding from the National Institutes of Health and industry appears to have decreased by 2% in 2008.

Indazole-based liver X receptor (LXR) modulators with maintained atherosclerotic lesion reduction activity but diminished stimulation of hepatic triglyceride synthesis.

A series of substituted 2-benzyl-3-aryl-7-trifluoromethylindazoles were prepared as LXR modulators. These compounds were partial agonists in transactivation assays when compared to 1 (T0901317) and were slightly weaker with respect to potency and efficacy on LXRalpha than on LXRbeta. Lead compounds in this series 12 (WAY-252623) and 13 (WAY-214950) showed less lipid accumulation in HepG2 cells than potent full agonists 1 and 3 (WAY-254011) but were comparable in efficacy to 1 and 3 with respect to cholesterol efflux in THP-1 foam cells, albeit weaker in potency. Compound 13 reduced aortic lesion area in LDLR knockout mice equivalently to 3 or positive control 2 (GW3965). In a 7-day hamster model, compound 13 showed a lesser propensity for plasma TG elevation than 3, when the compounds were compared at doses in which they elevated ABCA1 and ABCG1 gene expression in duodenum and liver at equal levels. In contrast to results previously published for 2, the lack of TG effect of 13 correlated with its inability to increase liver fatty acid synthase (FAS) gene expression, which was up-regulated 4-fold by 3. These results suggest indazoles such as 13 may have an improved profile for potential use as a therapeutic agent.