Is the quality of surgical residency applicants deteriorating?

Background: Among directors of general surgery residencies, there is a conc ern that the quality of medical students applying to surgical residencies i s declining. Methods: Quality of surgical applicants was assessed by several methods inc luding subjective opinions determined by survey and by objective data inclu ding student United States Medical Licensing Examination (USMLE) scores of matched candidates. The number of applicants interviewed, total interviews granted, proportion of Alpha Omega Alpha (AOA) students, and the rank order of the candidates matched was obtained by survey. The survey included data on postgraduate year 1 (PGY-1) residents from July 1996 to July 1999. Thre e mailings were made to 226 US surgical residency programs. Results: Data were obtained from 90 programs. Surgery program directors dis agreed with a survey statement that overall quality of applicants had decli ned (P <0.01), but agreed with a statement that activities of medical schoo ls to enroll graduating students into primary care had hurt recruitment (P <0.001). Objective data revealed no change in mean USMLE part I scores of P GY-1 residents over the 4 years (P = 0.265, power = 0.81). There was no cha nge in proportion of matched residents who were AOA over time. The mean sco re of all new PGY-1 residents, the rank of the first matched resident, the rank of the last ranked resident, and proportion of AOA students was higher in programs with five or more categorical spots when compared with program s of at most four (P <0.001). Across all programs, there was a trend to go lower on the rank list to fill categorical positions over time (P <0.001). Conclusions: There is a perception that medical school policies act to disc ourage recruitment of quality medical students into general surgery program s, and surgery programs are going deeper into their rank lists to fill cate gorical positions. However, the average USMLE part I score of applicants to surgical residencies and proportion of AOA applicants has not decreased. ( C) 2001 Excerpta Medica, Inc. All rights reserved.