The Costs of Applying to Residency: One Institution's Efforts to Increase Transparency.

OBJECTIVES: To provide students at our own institution with more accurate and granular data regarding the costs associated with applying for residency. METHODS: We created an electronic survey with >28 different fields delineating the costs associated with applying for residency. Demographic data, costs broken down by type of expenditure, and how these costs were financed were measured. Each year, graduating students at our institution took the survey in 2015, 2016, 2017, and 2018 before The Match. We then created a dynamic, user-friendly, and interactive Web-based application to display these data numerically and graphically for students to use while planning and preparing for The Match. RESULTS: There was a response rate of 48.9% (194/397). Overall, students completed an away rotation at a median of 1.0 (interquartile range [IQR] 0-2.0) programs and spent $1000 (IQR $292-$1606) per away rotation. They applied to a median of 30.0 (IQR 20.0-47.8) categorical programs and attended 12.0 (IQR 10.0-16.0) interviews. The cost per interview was $282 (IQR $192-$407). The total expenditures for preparing for residency were $4992 (IQR $3034-$8,274). These numbers varied significantly by intended specialty. Differences were noted between our data and those from both a regional and recent national cohort. CONCLUSIONS: The costs associated with applying for residency are relatively unknown and can be significant for some. Institutionally led efforts may allow students to more appropriately plan and budget for The Match. Other institutions may benefit from a similar program.

Fundamental Curriculum Change with 1-Year Pre-Clerkship Phase and Effect on Stress Associated with Residency Specialty Selection.

Vanderbilt University School of Medicine recently changed from 2 pre-clerkship years (Traditional curriculum) to a 1.5-year pre-clerkship phase for one class (Hybrid curriculum) to a 1-year pre-clerkship phase (Curriculum 2.0). This study investigated the relationship between shortened pre-clerkship training and stress associated with selecting a residency field. The surveyed graduating medical student population included one cohort from the Traditional and Hybrid curricula, and the first two cohorts from Curriculum 2.0. The authors modeled recollected stress levels using a Zero-Inflated Linear Mixed Model with additional covariate and random effects adjustments. Specialty decision-related stress levels increased in the Hybrid curriculum by 10.208 points [p = 0.0115, 95% CI 2.293, 18.122] on a 0-100 point scale. Curriculum 2.0 students had an insignificant increase in stress of 4.062 points [p = 0.304, 95% CI - 3.690, 11.814] relative to the Traditional curriculum. Time since starting medical school and time when a specialty was chosen were the largest factors associated with stress. While this study only evaluated a single facet of the potential downstream effects of curricular change, these data should inspire confidence for reform efforts as a significant increase in specialty decision-related stress present in Hybrid curriculum resolved in both cohorts of Curriculum 2.0.