M. D. Hsu1, S. Law1, A. Pathak1, P. Manhas1, D. Brahmbhatt1, A. Niu1, B. Maheta1, C. Goswami1, A. Noon2, M. Wong1 1California Northstate University College of Medicine, Elk Grove, CALIFORNIA, USA 2Geisinger Commonwealth School of Medicine, Scranton, PENNYSYLVANIA, USA
Introduction:
Some residency specialties have less than 300 spots each year nationwide, leading to an incredibly selective application process. As medical education continues to evolve, so do the factors contributing to what makes a specialty “competitive.” This study examines trends and factors that contribute to the competitive nature of these programs.
Methods:
Phase I of data collection involved compiling the factors used by six official medical school consulting and information organizations to rank the most competitive specialties. Based on the definitions set forth by these organizations and prior literature, an evidence-based equation was developed to calculate a specialty's "competitiveness score." Phase II involved extracting data from annual National Resident Matching Program Reports and the Association of American Medical Colleges Resident Reports regarding specialty-specific statistics such as average USMLE Step 1 scores, number of research publications, fill rate, etc (2013-2023).
Results:
49 specialties were analyzed using the following evidence-based equation:
Competitiveness Score = {3*[Fill Rate] + 3*[5*Unmatched Rate] + 2*[(?)*Step1] + 3*[(?)*Step2] + [30*Average Research Citations]}/12
Competitiveness Score (post-2021) = {[3*[Fill Rate] + 3*[5*Unmatched Rate] + [30*Average Research Citations]}/7
Figure 1 depicts the five most and least competitive specialties based on the average of the Competitiveness Score across the 2013-2021 application cycles. From 2015 to 2021, plastic surgery (integrated) had the highest surge (14.4) in the average number of research citations among accepted applicants. In obstetrics-gynecology, the average USMLE Step 1 score rose from 226.6 in 2015 to 230.6 in 2020, while the average USMLE Step 2 score had the greatest increase in neurological surgery and obstetrics-gynecology, from 246.9 to 250.7 and 241.8 to 245.6, respectively.
Conclusion:
Over the past decade, specialties considered to be the most "competitive" in the medical field have evolved due to factors such as global events, social movements, health equity research, and increased holistic assessments of applicants. Conversely, Plastic Surgery has continued to stay competitive, which may be influenced by the impact of social media and budding conversations concerning body image. Future directions may include better understanding the impact of USMLE Step 1 becoming Pass/Fail on how residency programs evaluate applicants.
