Saturday, 14 July 2012

Why Is Getting A Residency So Difficult? A Rational Analysis Of The Complex Problem

Getting a residency in US is a frustrating experience for all the applicants. Not only are those that are educated and learn from within the system are affected but add to that medical graduates trained in foreign systems and you have a whole new set of problems.   

Volume: The sheer number of applicants applying for few select spots in residency is the most obvious reason why many applicants are unsuccessful in getting a residency. But this is only one aspect of many that makes it difficult getting a successful residency. 

In order to figure out as to why this problem is so difficult we can use some attributes of a ‘difficult’ problem as elucidated by Dörner and Funke.

Intransparency: The process of getting into a residency is not entirely transparent. There are several areas where the applicant is left second guessing the proceedings.
  1. NRMP match algorithm: even though there is a lot available online and in publications regarding the algorithm, no one really ‘knows’ the algorithm.
  2. Criteria for selection of candidates for interview: These can be pretty nebulous and often not explicit in the match process.
  3. Criteria for ranking applicants.
This lack of clarity of the situation exists more in the continuation of the process than at the commencement. This often causes applicants to be attracted to the option of USMLE but the ‘continuation opacity’ quickly leads to frustration.

Complexity: the intricacy in the number of moving parts classifies this a ‘difficult problem’. There are multiple hurdles to cross and exceed including multiple steps of exams (USMLE 1, 2CS, CK and 3), getting verified as regards to documents and visa issues all encompass a significant numbers of items. Not just passing the exams but the scores themselves have a huge impact on interview chances. The interrelations of these items and decisions made all affect the final outcomes of getting a residency.

Dynamics: The time considerations of the application process also make this a difficult problem. There are temporal constraints that offer a very strict window of opportunity, which if missed greatly affects the chances of matching into a program. All documents, ECFMG certification and the application has to be complete by September 15th of the prior match year to have a fighting chance in the match. There is also an element of  temporal sensitivity where older graduates (with gaps in their CV), those who apply late, timing of exams or even timing of interview can affect the chance of matching.

One thing the residency application process does not have as a qualifying point for a complex problem is polytely, which is existence of multiple goals. Fortunately, there is one and only one goal for a residency applicant which is to get into a residency.

Thus one can see how the process of getting a residency in US is inherently a ‘difficult problem’. As with other complicated issues, there are several factors that work in tandem and stack against the international medical graduate applying for a residency in US. This article is not to deter an applicant from pursing their dream of post graduate medical education in US but to present a rational analysis of why it can get so frustrating to do so.  Understanding the intricacies of the issue will help an applicant prepare mentally for the challenges and anticipation of obstacles helps in better preparation.  

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