Introduction
Since its transition from an “early match” coordinated by the San Francisco match to the Main Residency Match® (“the Match”) in 2006, otolaryngology has remained one of the most competitive specialties in medicine.1,2The otolaryngology residency application and selection process is plagued by hyperinflation, wherein applications far outnumber available positions. Among all specialties, otolaryngology has the second highest ratio of graduating medical students ranking it first in the Match compared to available positions in that specialty (Ratio: 1.18), second only to plastic surgery (Ratio: 1.27).3Under such supply-demand discord, a proportion of graduating medical students risk an unsuccessful match, perpetuating the reputation that matching into otolaryngology is “impossible” or “near-impossible”.4
Previous studies evaluating the otolaryngology Match have attributed its competitiveness to a complex interplay between applicant factors (e.g., number of programs applicants applied to) and program factors (e.g., United States Medical Licensing Exam (USMLE) score and Alpha Omega Alpha (AOA) status screening, research requirements).4–6In the context of these factors, between 2007 and 2016 otolaryngology applicants’ mean USMLE Step 1 scores increased by 10 points (average score 248 in 2016); percent AOA membership increased by more than 5%; and the average number of abstracts, presentations, and publications per applicant more than doubled.5,7Fueled by shotgun approaches to applying, there has been a 250% increase in the mean number of applications-per-candidate over the last two decades.7,8
In the 2015 Match cycle, the Otolaryngology Program Director Organization (OPDO) required applicants to write a separate paragraph for each program (the program specific paragraph, or PSP) as a medium for candidates to express their specific interest in a program and reduce the number of applications submitted per applicant, thereby improving match rate success.9,10In the subsequent application year, the otolaryngology resident talent assessment (ORTA) was implemented as a concurrent prerequisite. The ORTA is a structured, telephone-based interview developed to assess non-cognitive attributes of applicants that are not systematically evaluated through traditional requirements such as USMLE board exam scores, AOA membership, and letters of recommendations. The ORTA was intended to yield psychometric-based predictions regarding which applicants would excel as otolaryngologists.11,12
Since the PSP and ORTA were enacted in 2015 and 2016, respectively, their implementation and characteristics have evolved: the PSP became optional in 2018 and starting in 2019 the ORTA was conducted post-match. While the PSP and ORTA have been suggested to contribute to declining applicant numbers (Figure 1 ), the implications of these interventions have not been thoroughly investigated. In this study, we sought to evaluate the impact of introducing and then removing these pre-match requirements on Match outcomes between the years of 2014–2021. We hypothesized that the introduction of the pre-match PSP and ORTA led to a decline in applicant numbers, and that medical students perceived the PSP and ORTA as barriers to otolaryngology, contributing to the downward trend observed in applicant numbers.