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ERAS: Can It Be Revamped? One Point of View

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Deepak Gupta at Self
Deepak Gupta
  • Self
Sarwan Kumar at Wayne State University
Sarwan Kumar
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ERAS: Can It Be
Revamped? One Point
of View
Each year, a large number of medical school
graduates apply for residency positions across
the United States. At the end of recruitment
processes, not all graduates have matched into their
desired residency programs to pursue their medical
career. The issue we would like to highlight here relates
to rethinking the process that generates millions of
electronic residency applications each year. Due to
logistics constraints, this large number of applications
cannot be appropriately and fairly reviewed by residen-
cy programs, even if they wanted to do so.
Per our calculations from previously available
online public data (although currently archived and
available only on request), 3.44 million applications
were submitted through the Electronic Residency
Application Service (ERAS) for residency programs in
2014.
1
Based on minimum fees of greater than or
equal to $9.50 per application, this resulted in more
than $30 million in gross revenues, representing over
one-fourth of the service programs’ revenues of the
Association of American Medical Colleges.
2
Howev-
er, this being said, the focus of our letter is not
revenues, but the redundant number of electronic
applications.
Filters used by residency programs to select
individuals for residency interviews allow only a
small percentage of submitted applications to even-
tually be reviewed by programs. These filters are in
place to manage the major logistic challenge of
reviewing hundreds or even thousands of applications
for each residency program, resulting in an unknown
percentage of submitted applications that are eventu-
ally reviewed. Examples of the filters available,
among others, include test scores, place of medical
school graduation, and years since graduation.
We suggest that residency programs should be
required to submit their annual updated filters to ERAS
before the application submission process begins mid-
September. That way, applicants would be able to run
screening scans to better understand the eligibility
standards for each program and their likelihood of
being selected for an interview. In this process, ERAS
could further serve its applicant community by offering
added useful services. Without increasing the burdenon
residency programs, these filters would allow applicants
to more appropriately focus their selection of programs
at the time of submitting the applications. In addition,
this approach would reduce the burden on residency
programs, as the programs would receive a lower
number of applications, which could then be reviewed
and given due consideration.
Additionally, residency programs, in collaboration
with ERAS, could explore the feasibility of paying for
(and issuing) ‘‘OVERRIDE tokens’’ to potential
applicants whose history with residency programs
may make them eligible for an interview, but whose
eligibility characteristics may not pass the preset
thresholds in the filtering process. In essence, such a
process would create a more feasible and transparent
application process by disclosing the existing filtering
processes used by programs. Applicants would benefit
from having a centralized screening of their applica-
tions’ eligibility for each program, using a transpar-
ent, objective, and disclosed filtering process.
In summary, this letter puts forth a point of view
that the filtering process currently used by residency
programs could be changed from the post-application
transmission stage to a pre-application submission
stage, so that only a limited and manageable number
of applications are actually transmitted to residency
programs, which can then give these applications
their due review.
Our hope is that the question ‘‘Can ERAS be
revamped?’’ can turn into ‘‘Yes, they can!’’
Deepak Gupta, MD
Clinical Assistant Professor, Anesthesiology, Wayne
State University
Sarwan Kumar, MD
Assistant Professor, Internal Medicine, Wayne State
University
References
1. Association of American Medical Colleges. Electronic
Residency Application Service (ERAS) data. https://www.
aamc.org/data/facts/erasmdphd.Accessed February 4,2016.
2. Association of American Medical Colleges. 2014 AAMC
Annual Report. https://members.aamc.org/eweb/upload/
2014%20Annual%20Report%20non-flash.pdf.
Accessed February 4, 2016.
DOI: http://dx.doi.org/10.4300/JGME-D-16-00015.1
Journal of Graduate Medical Education, July 1, 2016 467
TO THE EDITOR: OBSERVATIONS
... 6 Changes have been suggested in the field of ophthalmology and other specialties, including imposing limits on the number of applications submitted by an applicant, requiring supplemental essays to better gauge interest, and increasing the transparency of residency program selection criteria. [6][7][8] Previous studies examined the selection criteria for members of residency selection committees. 3 The preferences of applicants themselves have been described, with residentfaculty relationships, clinical or surgical volume, and diversity of training being most important for ordering rank lists. ...
... The mean (SD) age of respondents was 26.8 (2.7) years, with 77 women (41.6%) and a mean (SD) USMLE Step 1 score of 245. 8 ...
Current Applicant Perceptions of the Ophthalmology Residency Match
Article
  • Mar 2020
Importance The ophthalmology residency application process is critical for applicants and residency programs, and knowledge about the preferences of applicants would assist both groups in improving the process. Objective To evaluate the experiences and preferences of ophthalmology residency applicants. Design, Setting, and Participants This cross-sectional, nonvalidated survey was conducted online. All applicants to the Bascom Palmer Eye Institute ophthalmology residency program during the 2018-2019 application cycle were invited to complete the survey. Data collection occurred from April 1, 2019, to April 30, 2019. Main Outcomes and Measures Applicant demographics, application submissions, interview experiences, financial considerations, match results, and suggestions for improvement of the application process. Results Responses were received from 185 applicants (36.4%), including 77 women (41.6%). A successful match into an ophthalmology residency was achieved by 172 respondents (93.0%). There was a mean (SD) US Medical Licensing Examination Step 1 score of 245.8 (13.3) points. Respondents applied to a mean (SD) of 76.4 (23.5) ophthalmology residency programs, received 14.0 (9.0) invitations to interview, and attended 10.3 (4.4) interviews. Choices regarding applications and interviews were based mostly on program reputation, location, and advisor recommendation. A usual lead time of at least 3 weeks between the invitation and interview was reported by 126 respondents (69.2%), which was reduced to 14 respondents (15.1%) when a wait-list was involved. The ophthalmology residency application process cost a mean (SD) of 5704(5704 (2831) per applicant. Respondents reported that they were most able to reduce costs through housing choices (hotel stays or similar arrangements) and least able to reduce costs by limiting the number of programs to which they applied or at which they interviewed. Conclusions and Relevance The ophthalmology residency application process is complex and poses substantial challenges to applicants and residency programs. These findings suggest that many current applicants have difficulty selecting programs to apply to, and most respondents desired changes to the current system of interview invitations and scheduling.
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... 24,44,[50][51][52] Such limited preference signaling makes applicant interest explicit and may facilitate holistic review by residency programs, 44 but may increase applicant costs via third-party servicing fees. 50 Standardized Program Database: Twenty-one articles proposed the creation of a database w i t h s t a n d a r d i z e d p r o g r a m i n f o r m ation 4,5,15,17,18,24,[27][28][29]33,[41][42][43]50,[53][54][55][56][57][58][59][60] beyond data currently captured in the American Medical Association FREIDA Tool 61 and Association of American Medical Colleges (AAMC) Residency Explorer Tool. 62 Data captured may include program information (eg, curriculum, case logs, research opportunities, graduate outcomes), screening criteria (eg, USMLE scores, AOA status, DO/IMG status, publications), and metrics of previously matched applicants (eg, National Resident Matching Program [NRMP] statistical profiles). ...
Systems-Level Reforms to the US Resident Selection Process: A Scoping Review
Article
  • Jun 2021
Background Calls to reform the US resident selection process are growing, given increasing competition and inefficiencies of the current system. Though numerous reforms have been proposed, they have not been comprehensively cataloged. Objective This scoping review was conducted to characterize and categorize literature proposing systems-level reforms to the resident selection process. Methods Following Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, searches of Embase, MEDLINE, Scopus, and Web of Science databases were performed for references published from January 2005 to February 2020. Articles were included if they proposed reforms that were applicable or generalizable to all applicants, medical schools, or residency programs. An inductive approach to qualitative content analysis was used to generate codes and higher-order categories. Results Of 10 407 unique references screened, 116 met our inclusion criteria. Qualitative analysis generated 34 codes that were grouped into 14 categories according to the broad stages of resident selection: application submission, application review, interviews, and the Match. The most commonly proposed reforms were implementation of an application cap (n = 28), creation of a standardized program database (n = 21), utilization of standardized letters of evaluation (n = 20), and pre-interview screening (n = 13). Conclusions This scoping review collated and categorized proposed reforms to the resident selection process, developing a common language and framework to facilitate national conversations and change.
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... An abridged and edited version of this column was published in the July 2016 issue of the Journal of Graduate Medical Education (JGME). 4 The editors of JGME have granted permission for the complete and unabridged version to appear in this newsletter. ...
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The USMLE Step 1 Pass/Fail Reporting Proposal: The APDR Position
Article
  • Aug 2019
  • ACAD RADIOL
Background: The National Board of Medical Examiners (NBME) and the United States Medical Licensing Examination (USMLE) has convened a conference of "key stakeholders" on March 11-12, 2019 to consider reporting the results of the USMLE Step 1 as pass/fail. Discussion: While the original purpose of the USMLE Step 1 was to provide an objective basis for medical licensing, the score is increasingly used in residency applicant screening and selection because it is an objective, nationally recognized metric allowing comparison across medical schools in and outside the United States. Excessive reliance on the Step 1 score in the matching process has led to "Step 1 Culture" that drives medical schools to "teach to the test," increases medical student anxiety, and disadvantages minorities that have been shown to score lower on the USMLE Step 1 examination. The outsize role of the USMLE Step 1 score in resident selection is due to lack of standardization in medical school transcripts, grade inflation, and the lack of class standing in many summative assessments. Furthermore, the numeric score allows initial Electronic Residency Application Service filtering, commonly used by programs to limit the number of residency applications to review. Conclusion: The Association of Program Directors in Radiology (APDR) is concerned that pass/fail reporting of the USMLE Step 1 score would take away an objective measure of medical student's knowledge and the incentive to acquire as much of it as possible. Although the APDR is not in favor of the Step 1 exam being used as a screening tool, in the absence of an equal or better metric for applicant comparison the APDR opposes the change in Step 1 reporting from the numeric score to pass/fail.
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Association of American Medical Colleges
  • Feb 2014
Association of American Medical Colleges. 2014 AAMC Annual Report. https://members.aamc.org/eweb/upload/ 2014%20Annual%20Report%20non-flash.pdf. Accessed February 4, 2016.