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.