1. Evan Callahan OMS-III – Lake Erie College of Osteopathic Medicine
2. Ashini Patel OMS-III – Nova Southeastern Dr. Kiran Patel DO College of Osteopathic Medicine
3. Timothy Ackerman DO – Department of Orthopedic Surgery, UPMC Central PA

Abstract

Introduction  
During the 2021 match cycle, the use of a Universal Interview Offer Day (UIOD) was first introduced. During the 2022 cycle, the American Orthopedic Association Council of Orthopedic Residency Directors (CORD) encouraged the use of UIOD for orthopedic residency programs. This study aimed to assess the perceptions of the UIOD in orthopedic match applicants in the 2022 cycle.

Objectives 
The objectives of this study were to identify the perceptions of osteopathic medical students applying to orthopedic residencies, about the new and continued use of UIOD. Additionally, it looked at whether students understood what the process of UIOD was and if the programs they were applying to were participating.

Methods
To conduct our research, an anonymous survey was sent out to all current students via email in the Student American Osteopathic Academy of Orthopedics (SAOAO) database; additionally, it was posted to Instagram and Facebook social media accounts to reach a wider range of applicants. The survey had a total of 60 responses, 42 fit the selection criteria of United States students applying to the 2022 match cycle in osteopathic medical schools. 

Results
Results showed that 81% of students strongly or somewhat support the implementation of UIOD, 17% were neutral to it, and 2% were against it. Additionally, 12% of participants did not know what UIOD was before participating in the study; and 17% of students were unaware of which programs were participating in UIOD. The Orthopedic Residency Information Network (ORIN) database states that 147 residency programs participated in UIOD in the 2022 Match cycle, while 25 did not.

Figure 1: Results of student support of Universal Interview Offer Day.

Table 1: Percentage of students who support Universal Interview Offer Day

Figure 2: Results of student knowledge on which orthopedic programs were participating in universal offer day. 

Table 2: Percentage of students who knew which residency programs were participating in Universal Interview Offer Day

Figure 3: Student stress levels of the interview process after the implementation of Universal Interview Offer Day. 

Table 3. Percentage of students whose stress was affected by the use of Universal Interview Offer Day

Conclusion
Applicants largely support the continued use of UIOD in the orthopedic residency application process. Applicants also state that the use of UIOD has decreased their stress about the process. Additionally, many applicants did not know what UIOD was or how it was being used by programs around the country.

Keywords: education, match, residency, interview

Body

Introduction: Recently, the number of residency programs each applicant applies to has been steadily increasing. A recent survey showed that 81.5% of applicants were worried or very worried about the match and interview process.¹  These feelings of worry and stress have compounded in an ever increasingly competitive process leading to changes in applicant behavior. In 2008 the average orthopedics applicant applied to 54.1 programs while in 2018 the number grew to 85.7.² With this practice came increasing competition among students to secure interview spots. Orthopedic surgery is one of the most competitive specialties to match into; with an overall match rate of 59.5% in the 2022 match cycle.³ For the first time, during the 2021 match cycle, the American Orthopedic Association Council of Orthopedic Residency Directors (CORD) recommended the continued use of Universal Interview Offer Day (UIOD) with 64% of programs participating during the first year.⁴ Limited data has been collected on the initial use of UIOD during the 2021 match cycle and with only 64% of programs participating it was necessary to collect more data during the second year of UIOD usage. 

With the 2022 application cycle, CORD again suggested the use of UIOD for orthopedic residencies based on preliminary data from the previous year’s match cycle. According to The Orthopedic Residency Information Network (ORIN) database, 147 residency programs participated in UIOD, while 25 did not for a percentage of 85%, a significant increase from the year before.⁵

A survey of previous match applicants showed that 93% of applicants favored the use of UIOD.¹ However, many orthopedic surgery residencies did not participate in UIOD during the 2021 cycle causing many orthopedic applicants to not be included in this study. Additionally, there is no data specifically gauging the interest in orthopedic applicants who come from osteopathic medical schools. Given that 205 osteopathic seniors applied to orthopedic residencies in the 2022 match cycle, they represent 13.9% of all orthopedic applicants and should be examined thoroughly.³  Another study conducted showed that 81.5% of students applying to orthopedic surgery were worried or very worried about the interview offer process; while 64% of the students stated that they feel UIOD reduces their stress about the process.¹ A study of orthopedic program directors also showed that 83.1% of program directors would like to see UIOD continued in the future and 86.8% of program directors stated that they would participate in UIOD in the future if it continued to be used.⁴ 

The primary objective of this study was to query osteopathic orthopedic residency applicants regarding their perspective on the use of UIOD for the orthopedic residency process, and whether there is continued support for the use of UIOD in the future. In addition, we aimed to quantify the number of student applicants who knew what programs participated in UIOD, whether they supported UIOD and how to find that information. The study also aimed to assess students’ stress levels regarding the use of UIOD. This information will shed light on the student perspectives of this new application process and help match stakeholders to make informed decisions in the future about UIOD and the match process with specifics to orthopedic surgery. 

Methods
To conduct our research, a survey was created via SurveyMonkey. This anonymous survey was sent out to all current osteopathic students, via email, in the Student American Osteopathic Academy of Orthopedics (SAOAO) database; additionally, it was posted to social media accounts to reach a wider range of applicants including osteopathic and allopathic students. Social media outlets that the survey was promoted on included Instagram and Facebook. The survey had a total of 60 responses, and 42 fit the selection criteria of United States students applying to the 2022 match cycle in osteopathic medical schools. Afterward, the data was collected and analyzed to produce the conclusions of this study. During the 2022 match cycle 205 osteopathic seniors applied to orthopedics according to NRMP data;³ therefore this study captured 20.4% of all osteopathic senior applicants in the 2022 match cycle. 

Results
There were a total of 60 responses to the initial survey, 18 of which did not meet the inclusion criteria and were therefore not used for interpretation of the data. The majority of students participating in the survey were osteopathic medical students, and only one was an allopathic student. When asked about what kind of residency programs students were applying to; 95.2% of students were applying to traditionally osteopathic programs, 85.7% were traditionally allopathic programs, and 7.1% were in the military match. Results showed that 81% of students strongly or somewhat support the implementation of UIOD, 17% were neutral to it, while only 2% were against it. Additionally, 12% of participants did not know what UIOD was before participating in the study; and 17% of students were unaware of which programs were participating in UIOD. Furthermore, it was seen that the implementation of UIOD did decrease student stress levels during the process of interview offers. On a scale of 0-10, with 0 being no stress, and 10 being severely stressed about the interview process, 92.9% of students scaled at a 5 or above. After the implementation of UIOD, 54.8% of students reported having somewhat or greatly decreased stress levels; while 28.6% of applicants stated that they were either unsure of its effect on their stress levels or did not affect them at all. This left only 16.7% of applicants who believed that UIOD increased their stress about the application process. 

Conclusion
This study served to identify the perceptions of osteopathic medical students applying to orthopedic residencies, about the new and continued use of UIOD. Additionally, it looked at whether students understood what the process of UIOD was and if the programs they were applying to were participating. 

This study’s results concluded that the vast majority of osteopathic orthopedic applicants during the 2022 match cycle were in support of the continued use of UIOD for the residency match process. Additionally, more than half of the applicants also stated that the use of UIOD reduced their stress related to the match process while less than 17% of student applicants believed it increased their stress about the match process. The study also concluded that there was a significant portion of student applicants who were unaware of what UIOD was and also what programs were participating in it. 

Similar to previous surveys, a majority of student applicants support the use of UIOD. Additionally, osteopathic applicants support the use of UIOD on a similar level to previous studies that did not differentiate between osteopathic and allopathic students; 81% of osteopathic students strongly or somewhat supported the use of UIOD while 93% of undifferentiated students supported it in a previous study.¹ This is depicted in figure 1. Previous studies also indicated that 64% of students believed that the use of UIOD lowered their stress levels about the match process;¹ this study showed that osteopathic students applying to orthopedic surgery residency spots had similar outcomes with 54.8% of them stating UIOD lowered their stress levels about the process. 

The results of this study prove that osteopathic medical students applying to orthopedics in the 2022 cycle feel similarly to previous surveys that did not specifically look at osteopathic students separate from their allopathic counterparts. In addition, this study serves to corroborate the previous survey findings as that data was reproduced within this study. Specifically, students that participated in the 2022 orthopedic residency match also agree with the CORD recommendations, that implementation of UIOD should continue. Survey results from this study concur with these CORD findings as well. This study and previous studies show that the majority of applicants, both allopathic and osteopathic, support the continued use of UIOD in the future and state that its use has helped to lower their stress levels related to the match process. 

Given the overwhelming support from students, it is recommended that UIOD be continued for future match cycles (Figure 1). With the large percentage of students who did not know what UIOD was or which programs were participating it is recommended that CORD and other orthopedic residency organizations increase the amount of outreach and information available to potential applicants about how the process works (Figure 2). A campaign to increase awareness about how the match and UIOD process work should be a joint venture between CORD, residency programs, medical schools, and other match stakeholders. In addition, CORD should publicize the ability of ORIN to provide information to students about which programs participate in UIOD and which do not. This information can greatly help students in the application process. 

This study was limited to the reach of the SAOAO organization and focused on osteopathic students. This study only captured 42 of the 205 osteopathic applicants during the 2022 cycle, which is a smaller percentage of the 1,470 total applicants. This study also had a limited time frame, and extending the time frame for participation could have allowed for more responses. Continued follow-up with these same applicants and more students in the future would be beneficial to evaluate if these opinions continue to hold true several years from now.

In conclusion, a majority of osteopathic medical students that applied through the 2022 Match cycle are in support of the continuation of UIOD. However, given that many students were unaware of what UIOD was, it would be beneficial for CORD to provide more information on UIOD and how it can be helpful to student stress levels during the interview acceptance process. Additionally, marketing to students that ORIN provides information on which programs are participating in UIOD would be very beneficial in increasing the general knowledge of the match process. 

References

1. Jardaly, Achraf & Ponce, Brent & Balach, Tessa & Levine, William & Kogan, Monica & Patt, Joshua. (2021). Perceptions of the Universal Interview Offer Day in the Orthopaedic Surgery Residency Interview Process. Journal of the American Academy of Orthopaedic Surgeons. Publish Ahead of Print. 10.5435/JAAOS-D-21-00843. 
2. Chen, Antonia F. MD, MBA; Secrist, Eric S. MD; Scannell, Brian P. MD; Patt, Joshua C. MD, MPH Matching in Orthopaedic Surgery, Journal of the American Academy of Orthopaedic Surgeons: February 15, 2020 – Volume 28 – Issue 4 – p 135-144 doi: 10.5435/JAAOS-D-19-00313 
3. National Resident Matching Program, Results and Data: 2022 Main Residency Match®. National Resident Matching Program, Washington, DC. 2022.
4. Universal Interview Offer Day: American Orthopaedic Association. Available at: https://www.aoassn.org/programs/. Accessed March 27, 2021.
5. Orthopedic Residency Information Network (ORIN): American Orthopedic Association. Available at: http://orin.aoassn.org/#/search. Accessed April 4, 2022.

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