Research Methodology

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The researchers used data from applicants who applied through the AAMC Electronic Residency Application Service® (ERAS®) to residency programs in select specialties from 2013 to 2018. The exceptions are anesthesiology, dermatology, diagnostic radiology, neurology, radiation oncology, and urology, for which researchers used data from applicants who applied from 2013 to 2017.

The researchers used counts and percentages to calculate entrance rates by specialty, USMLE Step 1 score, and whether applicants failed the USMLE Step 1 Exam on their first attempt.

Entrance rate data come from the GME Track Residency Survey, which typically receives a response rate of about 94% (e.g., 94.4% in 2018), and tracks entrances of both seniors and medical graduates. These positions are tracked only in ACGME-credited programs. Please refer to the 2019 Report on Residents Executive Summary for further information on the GME Track Residency Survey.

The researchers used the number of programs an applicant applied to and the applicant’s most recent USMLE Step 1 score to predict whether an applicant entered a residency program in that application year. They used a specialized type of regression analysis known as “spline regression” to understand the relationship between the number of programs to which an applicant applied and entry into a residency program.

The study did not differentiate how applicants entered a program (e.g., National Resident Matching Program® Main Residency Match® or Supplemental Offer and Acceptance Program®).

For anesthesiology, dermatology, diagnostic radiology, neurology, radiation oncology, and urology, the researchers predicted whether an applicant entered a residency program within two years after their application because some programs in these specialties required a preliminary year.

It is not possible to determine, based on application numbers alone, whether a particular specialty was an applicant’s first choice of specialty; therefore, the definition of the applicant pool for each specialty is inclusive and incorporates anyone who applied to a program in that specialty, including those with one or two applications. Follow-up analyses demonstrate that there are no systematic increases or decreases in estimates of points of diminishing returns when removing those who submit a lower number of applications to a specialty (i.e., < 10 applications). 

Analyses were conducted separately for U.S.-MD, U.S. citizen international medical graduate (U.S. IMG), non-U.S. citizen international medical graduate (non-U.S. IMG), and U.S.-DO applicants. Data on specialty entrance rates and the point of diminishing returns are reported separately for each applicant type and specialty.

In some cases, DO entrance rates are not reported due to small sample sizes, and the points of diminishing returns were not estimated due to small sample sizes or program entrance rates. In some cases, IMG entrance rates are not reported due to small sample sizes. In all cases, the points of diminishing returns were not estimated for IMG applicants due to small sample sizes or program entrance rates. Finally, in the entrance rates tables, when the most common specialties where applicants enter training are listed, they are listed as the top three in order of frequency (ties included) and only if the number of applicants who enter in a specialty are greater than or equal to 10. Reporting results based on small sample sizes or program entrance rates would have resulted in unreliable estimates.

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Supporting the Transition to Residency

The transition to residency is a time of critical importance in a medical student’s journey to become a physician. The AAMC is developing tools and information to better support students, their advisors, and program directors during this phase.

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