Key changes recommended to the 2021 residency application cycle

For medical students, the past year was unlike any that trainees have encountered. The COVID-19 pandemic impacted where and how students train. Must notably in-person patient care—including clinical clerkships—was halted for the final two months of the academic year.

For prospective Class of 2021 medical school graduates, the disruptive effect of the virus on training will cause a residency application cycle that will also be unlike any other.

A recent set of recommendations from the Coalition for Physician Accountability (Coalition), a cross-organizational group of medical education stakeholders of which the AMA is a part, offers some insight on how medical schools, residency programs and students may encounter a different Match process in the coming year.

With the aim of creating an equitable, plausible residency selection process, the Coalition’s recommendations for potential changes to the final year of medical school and residency selection touched on three key areas: away rotations, the timing of the application cycle and residency program interviews. Here is a look at the key takeaways on each.

Often referred to as audition rotations, the Coalition’s recommendation calls for a significant reduction in the number of students who perform away rotations. Citing necessary limitations on travel, the Coalition called for away rotations to be discouraged.

The Coalition highlighted two instances in which learners could justifiably pursue away rotations: students who have a specialty interest and do not have access to a clinical experience with a residency program in that specialty in their school’s system may be allowed to pursue an away rotation in that specialty locally; and students for whom an away rotation is required for graduation or accreditation requirement should be allowed to meet that requirement.

“Essentially the Coalition felt very strongly that audition rotations should not be happening right now,” said Kim Lomis, MD, the AMA’s vice president for undergraduate medical education innovations and a member of the work group that formed the recommendations. “We don’t want to encourage that kind of travel, plus many health systems are saying it’s not a great time for someone who is not familiar with our system to come in from the outside during this kind of disruption.”

Medical students have had to adapt to much of their learning transitioning to digital forums. The same will likely be true of the residency interview process, with the Coalition recommending that residency interviews and campus tours be conducted virtually.

“This will be where the creativity of the programs comes into play,” Dr. Lomis said. “Interviews are a two-way street. An interview offers programs the opportunity to get to know the candidate. For the perspective resident, it’s a chance to get to see the facility, the culture and prospective housing. We’re anticipating programs [will] create online opportunities to get to know residents and faculty at their sites.”

The Electronic Residency Application Service (ERAS), a service that transmits students’ residency program applications, typically opens to residency programs in mid-September. Citing potential delays in students being able to take licensing exams and schools’ preparation of the medical student performance evaluation (MSPE)—often referred to as the dean’s letter -- the Coalition is calling for a slight delay in allowing residency programs to access applicant information.

On the whole, Dr. Lomis said the key takeaway for students regarding these changes is that they are designed with a fair application process as the end goal. Students are rightly concerned, since much of what they had previously been advised to do has now changed. But the programs know that.

“It’s important that everybody recognize this is complex,” she said. “The situations at different schools and in different programs vary. There’s no perfect solution. By looking out for the safety of patients and students, these guidelines promote more consistency across the country. We are aiming to provide the core requirements for training on both the student and resident side, and we want this process to be equitable throughout the application cycle.”

The AMA has curated a selection of resources to assist residents, medical students and faculty during the COVID-19 pandemic to help manage the shifting timelines, cancellations and adjustments to testing, rotations and other events at this time.