Standardized Assessment Tool for Surgery Applicants Reduces Attrition and Improves Board Pass Rate

Define Challenge: Review of applicants to surgery residency is difficult to standardize and is open to bias. In addition, proper assessment and identification can lead to improved retention and performance in residency. Tool Description: We developed a standardized tool to assess applicants in a holistic manner and stratify them for ranking. Methods: Applicants were graded on a scale of 0 to 3 on the following characteristics: medical school, USMLE Step Score, class standing, letter writer rank, letter of recommendation content categories (knowledge base, work ethic/teamwork, technical skills), MSPE content, Awards, and other activities. The overall score from the assessment tool was used to determine which applicants were invited for an interview and, in addition to interview scoring, to stratify applicants for the final rank. Results: From 2011 to 2017, a total of 60 residents were assessed and matched into the single ACGME-accredited general surgery residency program General Surgery Program by standard means. Prior to the utilization of this tool, the resident demographics were 58.3% men, 41.7% women, 58.3% under-represented in medicine (URM) with an 18.3% attrition rate, 5% remediation rate, and 64.3% first-time board pass rate. After the implementation of the assessment tool, a total of 38 residents were assessed and matched into the a single ACGME-accredited general surgery residency program from 2017 to 2023. The resident demographics were 57.9% men, 42.1% women, and 68.4% under-represented in medicine (URM), with a 7.9% attrition rate, 2.6% remediation rate, and 92.3% first-time board pass rate. The reduction in attrition rate and increase in first-time board pass rate between new and old methods was statistically significant (p < 0.01). Conclusion: Standardized assessment of resident applicants can help improve the identification of residents who will be successful in residency and help improve diversity within the residents. Programs directors can adapt this framework to help prioritize the objective characteristics they would like in their incoming residents and to increase the chances of success in their programs.