The association of a scholarly concentrations program with medical students’ matched residencies

ABSTRACT

Purpose

Many medical school curricula include Scholarly Concentrations (SC) programs. While studies have examined how these programs affect students’ future research involvement, the association of SC programs with students’ specialty choices is uncertain. This study examines the SC program factors associated with congruence between the specialty focus of students’ SC projects and the clinical specialty they matched into for residency.

Methods

The authors conducted a retrospective cohort study of all students participating in the SC program at Johns Hopkins University School of Medicine for graduating classes 2013–2020. They used data from program questionnaires to categorize students’ specialty interests (baseline) and SC program experiences (post-program). The authors categorized each student’s project into specialties according to their faculty mentors’ primary appointments, abstracted student publications from SCOPUS, and abstracted residency program rankings from Doximity Residency Navigator. The authors used multivariable logistic regression to calculate adjusted odds ratios (aOR) for specialty-congruent matching (same specialty as SC project) and for matching into a Doximity-ranked top 20 or top 10 program.

Results

Overall, 35.3% of the 771 students matched into the same specialty as their SC projects. Increased odds of specialty-congruent matching occurred with ‘definite’ interest in the specialty at baseline [aOR (95% CI): 1.76 (0.98–3.15)] (P = 0.06) and with increasing publications with SC mentors [aOR (95% CI): 1.16 (1.03–1.30)] (P = 0.01). Congruence between SC specialty focus and matched specialty conferred no significant difference in odds of matching to a Doximity-ranked top 20 or top 10 program.

Conclusions

Baseline certainty of specialty interest and research productivity were associated with specialty congruence. However, as completing an SC project in a given specialty was not associated with increased odds of matching into that specialty nor into a higher Doximity-ranked program, SC program directors should advise students to pursue SC projects in any topic of personal interest.

KEYWORDS:

• Scholarly concentrations
• medical student research
• specialty choice
• career choice
• curricular design

Introduction

Medical school is a time in which students explore and develop their interests in medicine and their professional identities as future physicians. Approximately 75% of medical students change their preferred residency specialty during medical school, reflecting the importance in exploring different specialties during medical school as students’ interests and envisioned careers change [1]. Factors influencing medical student career choice and potentially this change in preferred specialty include clinical experiences, scholarly experiences, academic interests, mentors, perceived prestige, income, lifestyle, training length, cumulative loan burden, and numerous other factors [2].

At many medical schools, students’ first scholarly experiences occur through Scholarly Concentrations (SC) programs and courses integrated into the curriculum [3–7]. These SC programs can engage medical students in scholarly research and connect students with faculty mentors in their specialties of interest from the first year of medical school. As this can oftentimes be a student’s first experience with a specialty and faculty within it, SC programs and early scholarly endeavors may influence career choice.

While numerous studies have examined how SC programs affect students’ future research productivity and involvement [8–11], few (if any) studies have examined how SC programs influence specialty choice [12]. In this study of medical students at the Johns Hopkins University School of Medicine, we evaluate the SC program factors associated with pursuing a residency in the same specialty as their SC project.

Methods

This study was approved by the Johns Hopkins University School of Medicine Institutional Review Board (IRB00103412). We performed a retrospective cohort study of all Johns Hopkins University School of Medicine medical students who completed the SC program and matched into residency programs between 2013 and 2020. The aims and curriculum for this SC program have been detailed by DiBase et al. and Sozio et al. [9,13] The exclusion criteria were as follows: students who did not participate in the SC program (students enrolled in the dual degree MD/PhD program), students who did not match into or pursue training in a residency program, and students whose post-graduate activities are unknown.

Specialty classification of SC projects and mentor fields

Each student’s SC project was classified into one of the following fields according to the primary clinical appointment of their faculty mentors: anesthesiology, child neurology, dermatology, emergency medicine, family medicine, general surgery, internal medicine, internal medicine-pediatrics, interventional radiology, neurological surgery, neurology, nuclear medicine, obstetrics and gynecology, ophthalmology, orthopedic surgery, otolaryngology, pathology, pediatrics, pediatrics-anesthesiology, physical medicine and rehabilitation, plastic surgery, psychiatry, radiation oncology, radiology, thoracic surgery, urology, vascular surgery. For the medical students who worked with faculty with non-clinical primary appointments (n = 139, 18.0%), the mentors were assigned to one of the previously listed specialties by taking into account the work and research interests of the faculty according to their faculty directory page and the nature of their published works. Two authors (S.M.S. and H.H.A.) each assigned these fields independently and then reviewed the assignments together. Differences were recorded and discussed, and then an assignment of mentor fields was made.

Data collection

We collected data on students’ baseline characteristics and academic interests, experiences with the SC program, and experiences with their mentors via survey administration at the beginning of the SC program during the first-year of medical school and following the completion of the SC program during the second year of medical school. We applied students’ responses to the Medical Student Scholar-Ideal Mentor Scale to evaluate the quality of mentorship students received in the domains of advocacy, responsiveness, expertise, and overall quality [14]. Data on each student’s publication metrics with their SC mentors were abstracted from SCOPUS.

Specialty categorization

We categorized specialties as low, middle, and high competitiveness based on the percentage of US senior MD graduates matching into the specialty sorted by percentage terciles according to the American Association of Medical Colleges 2021 Report on Residents (Supplemental Table 1) [15]. While all specialties impact the care of patients and all clinical specialties are person-oriented in nature, we further categorized specialties as ‘person-oriented,’ ‘surgical technique-oriented,’ and ‘non-surgical technique-oriented’ similarly to the methodology used by Manuel et al. (Table 1) [16].

Table 1. Baseline characteristics and matched residency outcomes of 771 medical students in the Johns Hopkins scholarly concentrations program, Graduation Years 2013–2020.

Factors	Full Cohort (N = 771) N, (%)
Publications Prior to Med School
Yes	158 (20.5%)
No	613 (79.5%)
Concentration
Clinical Research	367 (47.6%)
Public Health	222 (28.8%)
Basic Science	87 (11.3%)
HEART	52 (6.7%)
History of Medicine	43 (5.6%)
Field of SC Project
Person-Oriented	384 (49.8%)
Child Neurology	5 (0.6%)
Family Medicine	2 (0.3%)
Internal Medicine	268 (34.8%)
Internal Medicine-Pediatrics	0 (0%)
Medical Genetics	3 (0.4%)
Neurology	24 (3.1%)
Pediatrics	46 (6.0%)
Physical Medicine and Rehabilitation	3 (0.4%)
Psychiatry	33 (4.3%)
Technique – Surgical	300 (38.9%)
General Surgery	30 (3.9%)
Neurological Surgery	62 (8.0%)
Obstetrics and Gynecology	24 (3.1%)
Ophthalmology	47 (6.1%)
Orthopedic Surgery	27 (3.5%)
Otolaryngology	36 (4.7%)
Plastic Surgery	28 (3.6%)
Thoracic Surgery	21 (2.7%)
Urology	21 (2.7%)
Vascular Surgery	4 (0.5%)
Technique – Non-surgical	87 (11.3%)
Anesthesiology	14 (1.8%)
Dermatology	19 (2.5%)
Emergency Medicine	14 (1.8%)
Interventional Radiology	4 (0.5%)
Nuclear Medicine	1 (0.1%)
Pathology	11 (1.4%)
Pediatrics-Anesthesiology	1 (0.1%)
Radiation Oncology	14 (1.8%)
Radiology	9 (1.2%)
Mentor Academic Rank
Professor	357 (46.3%)
Associate Professor	280 (36.3%)
Assistant Professor	114 (14.8%)
Other	20 (2.6%)
Certainty of interest in field at time of mentored experience (n = 541)
No, Unsure	337 (62.3%)
Probably	147 (27.2%)
Definitely	57 (10.5%)
Congruence Between SC Specialty and Matched Specialty
No	499 (64.7%)
Yes	272 (35.3%)
Doximity-Ranking of Matched Residency Program
Top 20 Program	535 (69.4%)
Top 10 Program	395 (51.2%)

Abbreviations: SC, scholarly concentrations. HEART, Humanism, Ethics, Education, and the Arts of Medicine. NA, Not Available.

Ranking of “top 20” and “top 10” residency programs

The programs in each specialty were ranked according to the 2020–2021 Doximity Residency Navigator rankings sorted by reputation, and the ranking of the program each student matched to was recorded [17]. Programs not ranked in Doximity were assigned rankings using a related field as follows: radiology rankings for interventional radiology, pediatrics rankings for medical genetics, anesthesiology rankings for pediatrics-anesthesiology, general surgery rankings for thoracic surgery, and general surgery rankings for vascular surgery.

Statistical analyses

All statistical analyses were conducted using Stata, version 15.1 (StataCorp LLC, College Station, TX). Bivariate analyses were conducted to compare rates of specialty congruence when stratifying by specialty category of the SC project and residency competitiveness of the SC project specialty. Univariate and multivariate logistic regressions were used to calculate unadjusted (OR) and adjusted (aOR) odds ratios with 95% confidence intervals for the outcome of matching into the same field as the field of the SC project. The following variables were included in the multivariable analyses: certainty of student interest in the specialty of their SC project at the beginning of the SC program, the academic rank of the SC mentor, the SC program section, overall quality from the mentor scale as a continuous variable, and the number of any-authorship publications with their SC mentors as a continuous variable. We chose academic rank as our adjustment variable rather than other (correlated) metrics of mentors’ research history, as academic rank is most readily visible to a student choosing a mentor. We conducted an analysis using Bayesian Information Criteria to assess collinearity between these variables and found none.

Sensitivity analyses

To account for potential effects of student demographics on matched specialty congruence, we conducted univariable and multivariable logistic regressions looking at whether gender or race and ethnicity were associated with matched specialty congruence. To account for the effects of additional research dissemination experiences, we conducted univariable and multivariable logistic regressions examining whether plans for abstract submission at the conclusion of the SC course or publishing with mentors other than students’ SC mentors were associated with matched specialty congruence. We used the standard multivariable model in these sensitivity analyses. We conducted chi-square analyses to examine whether the frequency of first-author publications with students’ SC mentors was different between students with matched specialty congruence and students with matched specialty non-congruence by specialty.

Results

Baseline characteristics of cohort

This study included 771 students in the full cohort. There were 392 (50.8%) female students and 379 (49.2%) male students. Listed in descending order of frequency, 369 (51.0%) of students identified as White, 273 (37.7%) identified as Asian, 58 (8.0%) identified as Black or African American, 17 (2.4%) identified as multiple races, 4 (0.6%) identified as American Indian or Alaska Native, and 1 (0.1%) identified as Native Hawaiian or Other Pacific Islander. Of the five different concentrations in which students could pursue a scholarly project, students most commonly pursued their SC projects in clinical research (n = 367, 47.6%), followed by public health (n = 222, 28.8%), basic science (n = 87, 11.3%), humanism, ethics, education, and the arts of medicine (HEART) (n = 52, 6.7%), and history of medicine (n = 43, 5.6%) (Table 1). Students most frequently pursued their SC projects in person-oriented specialties (n = 384, 49.8%), followed by surgical technique-oriented (n = 300, 38.9%) and non-surgical technique-oriented (n = 87, 11.3%) specialties. Out of the 541 students who were asked about their certainty of interest in their SC specialty at the beginning of the SC program, 57 (10.5%) students reported having ‘definite’ certainty of interest in pursuing a residency in that specialty, 147 (27.2%) had ‘probable’ interest, and 337 (62.3%) reported that they were not certain (Table 1). By the time of graduation from medical school, the mean number of total publications and first-authored publications students had with their SC mentors was 1.12 (standard deviation: 2.34) and 0.48 (standard deviation: 0.92), respectively.

Summary of SC project and matched specialty congruence

Overall, 272 (35.3%) students matched in the same specialties as the specialty foci of their SC projects (Figure 1). When stratifying the analysis by specialty category of the SC project, the rates of matching to a congruent specialty were similar for person-oriented (125/384, 32.6%), surgical technique-oriented (116/300, 38.7%), and non-surgical technique-oriented (31/87, 35.6%) specialties (P = 0.25). When stratifying by residency competitiveness of the SC project specialty, congruence rates were similar for less competitive (107/323, 33.1%), moderately competitive (48/155, 31.0%), and highly competitive (117/293, 39.9%) specialties (P = 0.10) (Figure 1). Across all matched specialties, neurological surgery had the highest proportion (81.0%) of students who completed their SC projects in that specialty (Figure 2).

Figure 1. Congruence rates between matched specialty and SC project specialty by category for 771 medical students in the Johns Hopkins scholarly concentrations program, Graduation Years 2013–2020.Abbreviations: SC, scholarly concentrations.Bivariate analyses were conducted to assess whether there was any difference within categories in the proportion of students who matched into a congruent specialty.

Figure 2. Congruence rates between matched specialty and SC project specialty by specialty for 771 medical students in the Johns Hopkins scholarly concentrations program, graduation years 2013–2020.Abbreviations: SC, scholarly concentrations. N/A, not applicable (n = 0).

Univariable and multivariable logistic regression

As shown in Table 2, Supplemental Table 2, and Supplemental Table 3, we also conducted univariable and multivariable logistic regressions to calculate odds ratios for matching into the same specialty as that of a student’s SC project for several variables. Students with a ‘definite’ certainty of interest in pursuing a residency in their SC field at the time of the mentored experience had significantly increased odds [OR (95% CI): 1.91 (1.08–3.37)] (P = 0.03) of matching into that specialty compared to students who were uncertain on univariable analysis, though this was not significant on multivariable analysis [aOR (95% CI): 1.76 (0.98–3.15)] (P = 0.06) (Table 2). With each point increase in the advocacy scale of a student’s SC mentor, there were 1.10 (95% CI: 1.00–1.20) times increased odds (P = 0.03) of matching to a congruent specialty on univariable analysis, though this was not significant on multivariable analysis [aOR (95% CI): 1.05 (0.96–1.16)] (P = 0.27). Students with first-author publications with their SC mentors had significantly increased odds of matching to congruent specialties on univariable [OR (95% CI): 2.21 (1.60–3.07)] (P < 0.001) and multivariable [aOR (95% CI): 1.73 (1.16–2.57)] (P = 0.008) analyses. For each additional first-authored publication students had with their SC mentors, there were significantly increased odds of matching to congruent specialties on both univariable [OR (95% CI): 1.49 (1.24–1.79)] (P < 0.001) and multivariable [aOR (95% CI): 1.34 (1.07–1.67)] (P = 0.01) analyses. For each additional publication of any authorship position students had with their SC mentors, there were significantly increased odds of matching to congruent specialties on both univariable [OR (95% CI): 1.21 (1.11–1.32)] (P < 0.001) and multivariable [aOR (95% CI): 1.16 (1.03–1.30)] (P = 0.01) analyses. (Table 2). Neither gender nor race and ethnicity were associated with significantly different odds of matching to congruent specialties on univariable or multivariable analyses (Supplemental Table 2). We found no associations of specialty congruence with either abstract submission plans or publishing outside of the SC relationship (Supplemental Table 3).

Table 2. Univariable and multivariable analyses for congruence between SC specialty and matched specialty of 771 medical students in the Johns Hopkins scholarly concentrations program, graduation years 2013–2020.

Factors	Univariable		Multivariable
	OR (95% CI)	P value	aOR (95% CI)	P value
Student Characteristics
Certainty of interest in field at time of mentored experience (n = 541)
No, Unsure	1 [Reference]		1 [Reference]
Probably	1.16 (0.77–1.75)	0.48	1.17 (0.76–1.78)	0.48
Definitely	1.91 (1.08–3.37)	0.03	1.76 (0.98–3.15)	0.06
P trend	–	0.04	–	0.07
Mentor Characteristics
Academic Rank (n = 771)
Professor	1 [Reference]		1 [Reference]
Associate Professor	1.17 (0.84–1.62)	0.35	1.19 (0.79–1.79)	0.40
Assistant Professor	1.01 (0.65–1.58)	0.95	1.16 (0.635–2.09)	0.61
Other	1.05 (0.41–2.70)	0.92	1.40 (0.43–4.50)	0.58
Experiences within SC Program
Mentor Scale^a (n = 660)
Overall Quality	1.02 (0.99–1.05)	0.09	1.01 (0.98–1.04)	0.52
Advocacy	1.10 (1.00–1.20)	0.03	1.05 (0.96–1.16)	0.27
Responsiveness	1.05 (0.95–1.17)	0.36	1.01 (0.90–1.14)	0.83
Expertise	1.04 (0.98–1.10)	0.17	1.01 (0.95–1.07)	0.67
Concentration Section
Clinical Research	1 [Reference]		1 [Reference]
Public Health	0.93 (0.66–1.31)	0.69	1.10 (0.72–1.68)	0.65
Basic Science	0.85 (0.52–1.39)	0.53	0.91 (0.49–1.69)	0.76
History of Medicine	0.37 (0.17–0.82)	0.02	0.40 (0.14–1.10)	0.08
HEART	0.54 (0.28–1.05)	0.07	0.51 (0.22–1.19)	0.12
Products of the SC Program
First-authored publication(s) with mentor
Per each publication	1.49 (1.24–1.79)	<0.001	1.34 (1.07–1.67)	0.01
No	1 [Reference]		1 [Reference]
Yes	2.21 (1.60–3.07)	<0.001	1.73 (1.16–2.57)	0.008
Any publication(s) with mentor
Per each publication	1.21 (1.11–1.32)	<0.001	1.16 (1.03–1.30)	0.01
No	1 [Reference]		1 [Reference]
Yes	1.70 (1.24–2.32)	0.001	1.35 (0.92–2.00)	0.13

Abbreviations: OR, unadjusted odds ratio. aOR, adjusted odds ratio. CI, confidence interval. SC, scholarly concentrations. HEART, Humanism, Ethics, Education, and the Arts of Medicine.

^aSozio SM, Chan KS, Beach MC. Development and validation of the Medical Student Scholar-Ideal Mentor Scale (MSS-IMS). BMC Med Educ. 2017;17(1):1–7. doi:10.1186/s12909-017-0969-1

Table 3. Univariable logistic regression between specialty congruence and doximity ranking of matched program of 771 medical students in the Johns Hopkins scholarly concentrations program, graduation years 2013–2020.

	Top 20 Program^a				Top 10 Program^a
Group	OR (95% CI)	P value	aOR (95% CI)	P value	OR (95% CI)	P value	aOR (95% CI)	P value
Full Cohort
Non-congruent	1 [Reference]		1 [Reference]		1 [Reference]		1 [Reference]
Congruent	1.34 (0.97–1.87)	0.08	1.42 (0.95–2.14)	0.09	1.14 (0.85–1.54)	0.37	1.20 (0.83–1.74)	0.33
Competitivenessb
Low	1 [Reference]		1 [Reference]		1 [Reference]		1 [Reference]
Moderately	0.87 (0.59–1.28)	0.49	0.84 (0.53–1.34)	0.48	1.07 (0.75–1.52)	0.70	0.91 (0.59–1.40)	0.68
High	0.95 (0.63–1.42)	0.80	0.88 (0.53–1.45)	0.63	0.81 (0.56–1.16)	0.25	0.72 (0.45–1.13)	0.15
P trend	–	0.21	–	0.62	–	0.22	–	0.15

Abbreviations: OR, odds ratio. CI, confidence interval.

^aRankings according to 2020–2021 Doximity Residency Navigator for students’ respective matched specialties.

^bSpecialties were categorized as low, middle, and high competitiveness based on the percentage of US senior MD graduates matching into the specialty sorted by percentage terciles according to the American Association of Medical Colleges 2021 Report on Residents. ‘Low’ included family medicine, internal medicine, neurology, pathology, physical medicine and rehabilitation, and radiation oncology. ‘Moderately’ included anesthesiology, child neurology, emergency medicine, medical genetics, pediatrics, psychiatry, radiology, and general surgery. ‘High’ included child/adolescent psychiatry, dermatology, internal medicine-pediatrics, neurological surgery, obstetrics and gynecology, ophthalmology, orthopedic surgery, otolaryngology, plastic surgery, thoracic surgery, urology, and vascular surgery. The reference for each level of competitiveness is noncongruence between the specialty of SC and matched SC for students who completed an SC project in the competitiveness category.

We also conducted multivariable analyses for factors associated with increased odds of specialty congruence stratified by residency match competitiveness of the specialties in which students who completed their SC projects (Supplemental Table S4). For students who completed SC projects in highly competitive specialties, each first-authored publication with one’s SC mentor conferred significantly increased odds [aOR (95% CI): 1.45 (1.03–2.05) (P = 0.03)] of matching to the same specialty, but not for students who completed SC projects in moderately competitive [aOR (95% CI): 1.80 (0.98–3.32) (P = 0.06)] or less competitive specialties [aOR (95% CI): 0.85 (0.53–1.36) (P = 0.50)]. The frequency of first-author publications with SC mentors was significantly different between students with congruent matches and students with non-congruent matches for ophthalmology [congruent: 63% (13/21), non-congruent (23% (3/13); P = 0.03], otolaryngology [congruent: 83% (10/12), non-congruent 27% (6/22); P = 0.002], and urology [congruent: 73% (8/11), non-congruent 22% (2/9); P = 0.03] (Supplemental Table S5).

Doximity ranking of matched programs

On univariable analysis of the full cohort, congruence between SC specialty and matched specialty was not associated with significantly increased odds of matching to a Doximity-ranked Top 20 [OR (95% CI): 1.34 (0.97–1.87)] (P = 0.08) or Top 10 program [OR (95% CI): 1.14 (0.85–1.54)] (P = 0.37) (Table 3). These associations remained non-significant on multivariable analyses for both odds of matching to a Doximity-ranked Top 20 [aOR (95% CI): 1.42 (0.95–2.14)] (P = 0.09) or Top 10 program [aOR (95% CI): 1.20 (0.83–1.74)] (P = 0.33). Notably, when stratifying by the competitiveness of the residency match for which specialties students completed their SC projects, congruence between SC specialty and matched specialty remained unassociated with significantly increased odds of matching to a Doximity-ranked Top 20 or Top 10 program in both univariable and multivariable analyses (Table 3).

Discussion

While matching students into residency programs in the same specialties of their SC projects is not a goal of the SC program at our institution, this study is, to our knowledge, the first in the literature to evaluate SC programs’ potential influences on residency specialty choice at the end of medical school. We found approximately two-thirds of medical students at our institution match into a different specialty than the specialty focus of their SC projects. Furthermore, we found that publishing with one’s SC mentors during medical school was significantly and independently associated with a student pursuing residency in the same specialty as that represented by their SC project. Despite the potential for earlier exposure and more dedication to the field possibly represented by such congruence, we found that specialty congruence was not associated with significantly higher odds of matching into a higher-ranked residency program. These findings regarding students’ SC specialty choices, publication of SC projects, and matched residencies are highly relevant to other medical schools in planning their SC programs, refining their SC curricula, and offering evidence-based advising to students in SC programs to optimize their experiences.

Congruence rate

Over one-third of medical students (35.3%) in our program matched into a residency program in the same specialty as their SC projects. This is a slightly greater rate than that described by the AAMC Report on Residents, in which 27% of U.S. medical students reported a continuity of specialty preference between the Matriculating Student Questionnaire and Medical School Graduation Questionnaire [1], suggesting either a difference in our own program’s students or a difference in students’ research experiences. There was no significant difference in congruence rates between students when stratifying by SC specialty category or competitiveness, though students who had completed SC projects in surgical technique-oriented fields or highly competitive fields had slightly higher congruence rates. Nonetheless, the vast majority of students across all competitiveness or specialty categories matched into different specialties than the specialty focuses of their SC projects.

Factors associated with congruence

Our univariable analysis suggested that the number of manuscripts students published with their SC mentors and increased advocacy score of their SC mentor resulted in increased odds of matching to a residency in the same specialty as a student’s SC project. However, in multivariable analyses, only increasing publications with SC mentors remained significantly associated with increased odds of matching to a congruent specialty. It is notable that an increasing number of first-authored publications was significantly associated with increased odds of specialty congruence in students who pursued SC projects in highly competitive specialties, for which research productivity is a factor more strongly considered in matching these specialties [18]. This may be related to findings by Alberson et al., which showed that students in SC programs interested in highly competitive specialties placed higher importance on accomplishment-focused goals over skill-related goals [19]. Furthermore, our findings suggest that research productivity from an SC program may provide a positive feedback mechanism, influencing specialty choice for medical students in addition to increasing their competitiveness for residency.

Specialty congruence and ranking of matched program

We found that whether students in the full cohort matched into the same specialty as that of their SC projects does not affect their odds of matching to a Doximity-ranked Top 20 or Top 10 program. This was true after stratifying by specialty competitiveness as well. From our institution’s experience with first-year medical students at the onset of the SC program, students are oftentimes interested in multiple specialties and are concerned about which specialty to conduct their research to be competitive for residency applications should they apply into that specialty. Our findings for the full cohort show that even if students pursue their projects in a specialty different than the one they end up applying, this may not affect their odds of matching into a top-ranked program. Thus, these findings reinforce the importance for students to pursue SC projects they find interesting and with SC mentors they are interested in working.

Pertinence to SC curricular planners and research mentors

Medical student interest and recruitment into specialties are pertinent to physicians spanning all specialties of medicine [20–23]. Serving as an SC mentor for medical students not only offers SC mentors an opportunity to contribute to the development of medical students’ research skills, scholarly interests, and professional identity, but it also offers mentors the opportunity to work closely with medical students and build upon their shared research and specialty interests. Indeed, serving as a SC mentor is a commitment, and many faculty agree to be SC mentors because they are invested in their mentees’ futures as physicians and potential colleagues. These findings are applicable to SC mentors interested in recruiting medical students to their specialties, in which our findings show that both the mentor advocacy score and publication of students’ SC projects increase students’ odds of going on to match into that specialty. Furthermore, our findings that matched specialty congruence rate is not significantly associated with residency ranking can address student concerns about needing to complete their SC projects in certain specialties in order to match to those specialties, especially for students considering highly competitive specialties. However, the influence that the transition of the United States Medical Licensing Examination (USMLE) Step 1 to pass/fail scoring may have on these findings in the future is currently unknown.

USMLE step 1 transition to pass/fail scoring and future importance of specialty congruence

With the transition of the United States Medical Licensing Examination Step 1 to pass/fail scoring in 2022, meaningful research participation will become more important in assessing residency applicants [24]. With this increasing emphasis on meaningful research participation in the residency application process, student publications with their SC mentors will likely become more important in matching into that specialty in the coming years, especially in highly competitive specialties. However, any shifting importance of conducting an SC project in the same specialty as one’s intended specialty is unknown currently. Furthermore, while specialty congruence was not associated with significantly increased odds of matching to a Top 10 or Top 20 residency program in our cohort, it is unknown at this time whether this may change in the future with the PD-reported increases on meaningful research participation.

Limitations

There are several limitations to this study. First, though the sample size of the cohort is large, spanning eight graduating classes, this is a single-institution study which may limit the generalizability of our findings. Generalizability of this study is further limited in that the institution at which this study occurred has robust clinical and research resources in all specialties along with a strong history in match outcomes in nearly all specialties for its medical students. Thus, we advise readers that this study’s findings should be interpreted with consideration of the resources and emphases of their own institutions when planning and refining their SC programs. In addition, our methodology for categorizing the specialty focus of each student’s SC project is limited in situations where SC mentors support SC projects with specialty focuses outside of their own primary appointments. Furthermore, our findings can only report an association, not causation, between students publishing with their SC mentors and matching into the same specialties as that of their SC projects. It is also possible that students who are highly committed to a specialty at the time of conducting their SC projects may also be motivated to publish this project and others with their SC mentors. Thus, the association between students publishing with their SC mentors and matching into the same specialties as their SC projects may be facilitated by bidirectional influence of both factors on each other. Additionally, we did not have data available on the primary reason for students pursuing a different specialty for residency than that of their SC project. Examples of potential reasons for incongruence would be students developing an interest in a different specialty or not being competitive enough to match into a residency program in the specialty of their SC projects. Furthermore, while there are other forms of research dissemination such as abstracts and presentations that could have been abstracted from medical students’ residency applications in the Electronic Residency Application Services (ERAS), there are numerous studies that have demonstrated unverified or misrepresented research in students’ ERAS applications across several specialties [25–31]. Given the potential variability in this student-entered data in ERAS, we considered publications to be the most objective measure of research dissemination for our study and thus did not include student abstracts or presentations. In addition, we grouped specialties by competitiveness and technique- versus person-oriented specialties in our sub-analyses consistent with the grouping used in previous studies [18,19], though other ways of grouping specialties may be possible. Grouping specialties by competitiveness is limited by fluctuance in specialty competitiveness over time. Grouping residency specialties by person-oriented versus technique-oriented specialties is limited as well; for instance, internal medicine is categorized as a person-oriented specialty, though subspecialties of internal medicine, such as gastroenterology, are highly procedural in practice., The study is further limited in that Doximity does not perfectly represent the ‘Top 20’ or ‘Top 10’ residency programs in each specialty. However, in a study by Smith et al., 79% (977 of 1241) of residency applicants across 24 graduate medical education programs reported that Doximity Residency Navigator’s reputation rankings influenced their application, acceptance of interview offers, or rank list decisions [32]. Rolston et al. demonstrated in a survey of emergency medicine residency applicants that one-quarter of applicants made changes to their rank list according to Doximity rankings [33]. Given these findings, we felt Doximity rankings served as the best option for program ranking outcomes. Finally, we only know the students’ matched specialties; we do not whether students may have intended to pursue a different specialty but did not match to it, nor do we know whether students ultimately did not apply to their preferred specialties due to concern about not matching or other influencing factors.

Conclusions

While most students match in a specialty different than that of their original SC project, students with congruence between their matched and SC specialty were more likely to have high scores on mentor advocacy, projects culminating in publication, and ‘definite’ certainty in the field at the time of their mentored experiences. The specialty of the SC project was not significantly associated with matching into that specialty, nor was congruence between SC project specialty and matched specialty significantly associated with the Doximity ranking of a student’s matched program. Given our findings, SC program directors should advise students to pursue whichever SC projects are interesting to them at that time and with mentors whom they would enjoy working with. However, as this is a single-institution study, SC program directors should also ultimately consider the resources and emphases of their own institutions when designing and modifying their SC programs.

Ethical approval

This study was approved by the Johns Hopkins University School of Medicine Institutional Review Board (IRB00103412).

Previous presentations

Preliminary findings from this study were presented as an abstract at the Association for Medical Education in Europe Annual Conference in Lyon, France, August 27–31, 2022.

Acknowledgments

The authors wish to thank the students at the Johns Hopkins University School of Medicine for their engagement in the SC program. The authors would also like to thank other SC program faculty leaders and administrative support at the Johns Hopkins University School of Medicine whose contributions to the SC program made this study possible: Bhakti Hansoti, MBChB, PhD, MPH.; David Friedman, MD, PhD; Sarah Wheelan, MD, PhD; Marc Halushka, MD, PhD; John Lorsch, PhD; Marta Hanson, PhD; Jennifer Haythorthwaite, PhD; Megan Reller, MD, MHS; John Strouse, MD, PhD; Joseph Caresse, MD, MPH; Gail Geller, ScD, MHS; Randall Packard, PhD; Nathaniel Comfort, PhD, MS; Jeremy Greene, MD, PhD, MA; Michele Massa, BS; Carly Wasserman, MAT; Jill Rice, MS; and Delena Dodd.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

There is not a data set associated with this study.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10872981.2023.2234651.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.