Student academic performance factors affecting matching into first-choice residency and competitive specialties

BackgroundAlthough specific specialties and residency programs have investigated student performance factors affecting matching, there is a paucity of information from medical schools. Furthermore, factors contributing to matching into first-choice residency have not been examined. This study aimed to identify academic performance factors affecting matching into first-choice residency and highly competitive specialties.MethodsThe authors conducted a study of 1726 graduates from their institution from 2010 to 2017 and assessed pre-/post-admission academic variables associated with matching into first choice and highly competitive specialties.Results53.9% of graduates matched into their first choice. This was associated with passing COMLEX Level 2CE (p=0.01), PE (p=0.02) on first attempt, and higher COMLEX Level 2CE and USMLE 2 CK scores (p<0.001 and 0.002; 14.1 and 3.9-point difference in mean scores respectively). Pre-clinical GPA (p=0.002) and highest MCAT score (p=0.02) were associated, however differences in means were<1 point for both. Factors associated with matching into first choice included: MCAT (OR 0.95, 95% CI=(0.92, 0.98)), Level 2CE score (OR=1.01, 95% CI=(1.01, 1.02)) and passing Level 2 PE (OR=3.68, 95% CI=(1.2,11.28)). 12% of graduates matched into high- and 63% into low-competitiveness specialties. Matching into highly competitive specialties was associated with passing COMLEX Level 1 (p<0.001), Level 2CE (p<0.001), USMLE Step 1 (p<0.001) and Step 2 CK (p=0.03) on first attempt. Mean scores of students matching into high- versus low-competitiveness specialties differed as follows: COMLEX Level 1 62.7 points, Level 2CE 50.5 points, USMLE Step 1 13.6 points, Step 2 CK 7 points (all p<0.001), as did pre-clinical GPA (2.4 points, p<0.001). Level 1 score was the strongest predictor for matching into highly competitive specialties (OR=1.04, 95% CI=(1.02, 1.05)).ConclusionsLicensing exam performance is important for matching into first-choice residency and into highly competitive specialties. Differences in exam scores were more pronounced for matching into highly competitive specialties than into first choice, with a larger difference in mean scores between students matching into specialties of high versus low competitiveness, than between students matching into their first- versus non first-choice residency. These results may help faculty prepare students and inform curriculum design to improve matching.