Keywords
ophthalmology - residency - match - COVID-19 - home match - home-institution match
- San Francisco Match
The coronavirus disease 2019 (COVID-19) pandemic has affected all aspects of the ophthalmology
residency application cycle. Multiple changes for the 2020 to 2021 San Francisco (SF)
Match cycle included reduced opportunity for in-person away rotations, centralized
interview scheduling with a new cap on maximum interviews, and a switch to mandatory
virtual interviewing. Retrospective analysis of other 2021 residency specialty matches
including otolaryngology,[1]
[2] plastic surgery,[1]
[3]
[4] and dermatology[5]
[6] have noted significantly increased home-institution residency match rates when compared
with previous years. Interestingly, urology and neurosurgery also had higher home-institution
match rate trends but did not achieve statistical significance.[1] We hypothesized that there was an increased rate of SF Match rates to the home residency
program during the COVID-19 and described the potential reasons for this statistically
significant trend. To our knowledge, this is the first report to confirm the increased
home-institution match rate of ophthalmology residents during the COVID-19 pandemic.
Materials and Methods
Aggregate deidentified summative SF Match data from 2017 to 2022 was obtained from
the Association of University Professors of Ophthalmology (personal communication,
Steven Feldon, MD). The SF Match data included totals for number of residency positions
offered, positions filled, and number of students matching at home programs. A home-institution
match was defined as a student matching at his/her medical school affiliated residency
program. Statistical analyses were performed with Microsoft Excel (Microsoft, Redmond,
WA). Results were analyzed with a chi-squared test for difference in proportions with
p < 0.05 considered significant.
Results
[Table 1] shows the number of residency positions offered, positions filled, and number of
students matching at a home institution. There was a significant increase in home
match rates for 2021 when compared with the combined years of 2017 to 2020 (p = 0.004). Similarly, a significant increase in home match rate was seen in 2022 when
compared with the combined years of 2017 to 2020 (p = 0.02). In addition, a significant increase in home match rate was demonstrated
when comparing the combined 2021 to 2022 years to the combined years of 2017 to 2020
(p = 0.001). There was no significant difference in home match rates between 2021 and
2022 as individual years (p = 0.65).
Table 1
Ophthalmology home-institution match data from 2017 to 2022
|
Match year
|
Positions offered
|
Positions filled
|
Matched to home institution (n)
|
Matched to home institution (%)
|
|
2017
|
468
|
462
|
86
|
18
|
|
2018
|
475
|
475
|
75
|
16
|
|
2019
|
485
|
484
|
84
|
17
|
|
2020
|
496
|
495
|
90
|
18
|
|
2021
|
499
|
498
|
115
|
23
|
|
2022
|
509
|
507
|
111
|
22
|
|
2017–2020 vs. 2021
|
p = 0.004*
|
|
|
2017–2020 vs. 2022
|
p = 0.02*
|
|
2017–2020 vs. 2021–2022
|
p = 0.001*
|
|
2021 vs. 2022
|
p = 0.65
|
Abbreviation: COVID-19, coronavirus disease 2019.
This table shows the variation of home-institution matches from 2017 to 2022. There
is a statistically significant difference in the 2021 and 2022 years when compared
with the 2017 to 2020 pre-COVID-19 baseline.
The asterisks indicate statistical significance.
Discussion
Our findings are consistent with retrospective 2021 residency match analyses for otolaryngology,
plastic surgery, and dermatology. Although neurosurgery and urology had increased
trend rates of home-institution match rates, these results did not reach statistical
significance. Faletsky et al noted that urology had a higher proportion of matched
non-US senior graduates and neurosurgery had a higher proportion of international
medical graduates (IMGs) when compared with otolaryngology and plastic surgery.[1] The authors speculated that these groups may have “diluted” the home-institution
match numbers leading to the observed statistical nonsignificance.
Outside of the medical specialties mentioned, we were unable to find reports on home-institution
match rates for other medical specialties on the PubMed database using combinations
of search terms “home,” “match,” “residency,” and “COVID-19” and reference checking
of cited material.
The strength of our dataset is that it reflects the complete ophthalmology match and
does not rely on self-reporting or survey data. The main weakness is that the limited
summary data does not allow us to look for specific factors that may be driving the
observed trend. In addition, we only have the home-institution program data and not
the home city (where multiple programs might exist in the same city or region). We
also suspect that the no-match rate for candidates without a home program or for multiple
candidates from the same institution might also be higher given the trends toward
higher acceptance to home programs.
Future variables for study might include presence or absence of a home program, possible
concurrent changes in region-based matching, relevance of program size or geographic
location, effect of completed virtual or in-person rotations during the pandemic,
and changes in the matched number of nonsenior and IMG candidates. In dermatology,
while the home-institution match rate increase was significant, the home-region match
rate was not.[5] It was also noted that larger dermatology programs were more likely to match home
candidates.[6] Both otolaryngology and plastic surgery noted a reduced match rate for applicants
without a home program.[2]
[3]
One hypothesis for the increased home-institution match rate in ophthalmology is that
it is directly related to COVID-19 restrictions on away rotations. This is the leading
hypothesis from nearly all dermatology, otolaryngology, and plastic surgery publications
reporting increased home-institution match rates.[1]
[2]
[3]
[4]
[5]
[6] Plastic surgery noted an increased match rate if a virtual rotation was performed.[4] Since our relative increase in home matches is ∼25 students, it would be interesting
to see if there is a subset of ophthalmology applicants or programs that place a higher
emphasis on the away rotation when creating a rank list. The published data on ophthalmology
away rotations remains limited and is another area of possible future research focus.
A second hypothesis for the increased home-institution match rate is that it is only
indirectly related to COVID-19 and more directly a result of the shift to virtual
interviewing. A 2021 survey of ophthalmology applicant and program perceptions of
the 2020 to 2021 application cycle found that a majority of both medical students
and program directors had a preference for in-person interviews, specifically noting
the ability to “connect” with faculty.[7] Abdelwahab et al suggested one factor for dermatology's increased home-institution
matches was a program's unfamiliarity with outside applicants secondary to virtual
rotations and virtual interviewing potentially leading to higher ranking of internal
candidates.[6]
Conclusion
Compared with 2017 to 2020, there was a statistically significant increase in home-institution
matches for the 2021 and 2022 ophthalmology residency match cycles. This coincides
with the COVID-19 pandemic and mirrors a trend seen in otolaryngology, dermatology,
and plastic surgery for the 2021 match. Additional study of accessible ophthalmology
match data, potentially with a survey of both recent applicants and programs, is needed
to identify and delineate possible factors leading to this observation.
