Medical residency match applicants undervalue factors that predict stress and burnout

Figures & data

Table 1. Medical residency applicants were asked to report the five factors that were most important to them in making decisions about their Rank Order List. These open-ended responses were categorized into eight categories. The numbers represent the percentage of participants who listed each decision factor as being 1st, 2nd, 3rd, 4th, or 5th most important in their decision-making process.

	Location	Training	Prog. Culture	Relations	Prestige	Post-residency opportunity	Finances	Other
1st	46.7	17.6	17.6	6.0	8.8	2.7	-	0.5
2nd	19.2	22.5	26.4	3.8	14.8	6.6	-	6.6
3rd	14.9	20.4	24.3	6.6	11.0	8.3	1.7	12.7
4th	8.6	26.4	23.6	2.3	8.6	11.5	5.2	13.8
5th	7.3	21.8	26.7	5.5	10.3	8.5	9.1	10.9

Participants were asked to list the ‘five factors that were most important to you in making decisions about your ROL.’

Table 2. Participants rated the importance of each of 24 factors in their decisions for Rank Order Lists on a 9-point scale from not important (1) to extremely important (9). Factors were combined in some cases into superordinate categories, presented in bold below. The numbers represent the mean (M) rated importance of each factor, accompanied by the associated Standard Deviation (SD).

Decision Factor	M	SD
Location	8.3	1.3
Prestige – Reputation of program	7.1	1.7
Post-residency opportunity (average of items below)	7.0	1.7
Career paths of recent program graduates	7.2	1.5
Quality of preparation for fellowship	6.9	2.2
Program culture (average of items below)	6.9	1.1
Gut feelings about overall goodness of fit with the program	8.4	1.2
Gut feelings during interview visit	8.1	1.4
Morale of house staff and current residents	8.0	1.3
Rapport with program leadership	7.5	1.5
Work/life balance	6.9	1.9
Program’s flexibility to pursue electives and interests	6.3	2.0
Size of patient caseload	6.1	1.9
Cultural/racial/ethnic/gender diversity at institution	5.6	2.6
Call schedule	5.1	2.2
Relationship (average of items below)	6.8	2.2
Support network in the area	7.0	2.4
Needs of partner, spouse, or family	6.7	2.8
Training (average of items below)	6.7	1.1
Quality of clinical training	8.2	1.1
Appropriate balance between faculty supervision and resident responsibility for patient care	7.2	1.6
Diversity of patient problems or procedures	7.0	1.7
Quality of hospital facilities	6.7	1.8
Research opportunities	6.0	2.4
Size of program	5.1	2.2
Finances (average of items below)	4.8	2.3
Cost of living in the area	5.0	2.5
Salary, benefits	4.6	2.5
Likelihood of matching	4.5	2.8

Figure 1. Participants rated the intensity of their responses of happiness, excitement, stress, and life satisfaction shortly after learning the outcome of Match Day on a 9-point scale from not at all (1) to most extreme possible (9). These responses are broken out in the figure according to whether they matched with their 1st choice, their 2^nd choice, their 3rd choice, or their 4^th or lower choice. Values represent the mean rated intensity of each response after Match Day, accompanied by the associated Standard Deviation.

Figure 2. Participants rated the intensity of their responses of happiness, excitement, stress, and life satisfaction after beginning their residency program on a 9-point scale from not at all (1) to most extreme possible (9). These responses are broken out in the figure according to whether they matched with their 1st choice, their 2nd choice, their 3rd choice, or their 4th or lower choice. Values represent the mean rated intensity of each response, accompanied by the associated Standard Deviation.

Table 3. Participants rated the perceived alignment between themselves and the program on 9-point scales from does not meet my needs at all (1) to perfectly suited to my needs (9), as well as their responses shortly after Match Day on 9-point scales from not at all (1) to most extreme possible (9). The table presents the results from linear regression analyses with rated congruency on each factor predicting responses of happiness, excitement, stress, and life satisfaction shortly after Match Day. β represents the standardized beta value.

	Happiness			Excitement			Stress			Life satisfaction
	R^2 = 0.5, F = 21.0, p < 0.001			R^2 =0 .5, F = 17.3, p < 0.001			R^2 = 0.3, F = 7.0, p < 0.001			R^2 =0.5, F = 18.4, p < 0.001
	β	t	p	β	t	p	β	t	p	β	t	p
Reputation	0.3	3.7	0.001	0.2	2.6	0.01	0.2	1.9	.06	0.4	4.4	0.001
Location	0.1	1.1	0.3	0.1	0.9	0.4	−0.1	−1.3	.2	0.1	0.7	0.5
Program Culture	0.3	3.5	0.001	0.3	3.1	0.002	−0.2	−1.6	.1	0.2	1.9	0.05
Opportunity	−0.0	−0.2	0.8	0.0	0.0	1.0	−0.2	−1.4	.2	−0.1	−0.9	0.4
Relationship	0.2	1.9	0.1	0.1	1.5	0.1	−0.1	−0.7	.5	0.1	1.3	0.2
Training	0.0	0.3	0.8	−0.0	−0.0	1.0	−0.1	−0.6	.5	−0.0	−0.2	0.8
Finances	0.0	0.0	1.0	0.1	0.8	0.4	−0.0	−0.3	.8	0.1	0.8	0.4
Time 1	0.1	2.2	0.03	0.1	2.4	0.02	0.3	3.7	.001	0.3	5.7	0.001

Table 4. Participants rated the perceived alignment between themselves and the program on 9-point scales from does not meet my needs at all (1) to perfectly suited to my needs (9), as well as their responses after beginning their residency program on 9 point scales from not at all (1) to most extreme possible (9). The table presents the results from linear regression analyses with rated congruency on each factor predicting responses of happiness, excitement, stress, and life satisfaction after starting their residency program. β represents the standardized beta value.

	Happiness			Excitement			Stress			Life satisfaction
	R^2 = 0.2, F = 4.4, p < 0.001			R^2 = 0.2, F = 4.5, p < 0.001			R^2 = 0.1, F = 3.0, p < 0.004			R^2 = 0.3, F = 9.8, p < 0.001
	β	t	p	β	t	p	β	t	p	β	t	p
Reputation	0.1	0.9	0.4	0.2	1.5	0.2	0.1	0.6	0.5	0.2	2.3	0.02
Location	0.0	0.2	0.9	0.1	0.8	0.4	−0.1	−0.9	0.4	0.0	0.2	0.8
Program Culture	0.4	2.9	0.004	0.3	2.7	0.01	−0.4	−3.1	0.002	0.4	3.5	0.001
Opportunity	−0.1	−1.3	0.2	−0.2	−1.9	0.06	0.1	1.0	0.4	−0.1	−1.1	0.3
Relationship	0.2	2.0	0.8	−0.0	−0.4	0.7	0.1	1.2	0.2	0.1	0.7	0.5
Training	−0.0	−0.0	1.0	−0.0	−0.1	0.9	0.1	.6	0.5	−0.1	−.07	0.5
Finances	0.1	0.1	0.1	0.1	1.5	0.1	−0.1	−0.9	0.4	0.1	1.0	0.3
Time 1	0.1	0.8	0.4	0.1	1.8	0.1	0.2	2.7	0.01	0.3	3.6	0.001