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    AAMC Research and Innovations Supporting the Residency Application Process

    The AAMC is regularly exploring ways to improve the residency application process through initiating its own research, supporting research led by other stakeholders in the academic medicine community, and making improvements to the ERAS® program. Not all research yields changes to the application process, but each project has the potential to inform the AAMC — and its partners — in creating future innovations.  

    Active AAMC research and innovations

    • Data to help medical schools improve their curricula: The 2023 Resident Readiness Survey recently launched on January 2, 2024. The Resident Readiness Survey is a national, standardized survey for program directors to share the preparedness of PGY-1 residents with their respective graduating medical schools. All residency programs with 2022-2023 graduates from the 174 participating medical schools (149 MD schools and 25 DO schools) have until February 23 to complete the surveys in GME Track. For more information, please visit the Resident Readiness Survey website or email ResidentReadiness@aamc.org

    • USMLE Step 1 Exam and COMLEX-USA LEVEL 1 Pass-Fail Transition Collaborative Research: In February 2020, the National Board of Medical Examiners (NBME) announced that it would only report pass/fail outcomes for USMLE Step 1 exams taken on or after January 26, 2022, with the National Board of Osteopathic Medical Examiners (NBOME) following with a similar announcement for COMLEX-USA LEVEL 1 exam scores. This, in part, led the AAMC, NBME, National Resident Matching Program® (NRMP®), American Association of Colleges of Osteopathic Medicine (AACOM), and NBOME to collaborate on a research program that evaluates the impact of this change both during and after the transition to residency. The multi-year research agenda will establish a baseline before pass/fail outcomes are reported for all applicants and explore changes over time. Research results will provide the community with information about current and planned future practices for students and advisors and identify any need for training and guidance regarding best practices for appropriate use, fairness, and validity in selection. 

    • ERAS Application

      • Supplemental ERAS Application: For the 2024 ERAS cycle, content from the Supplemental ERAS Application was moved into the main ERAS application. This updated application content is designed to help students share more about themselves and assist program directors in finding applicants that fit their programs’ setting and mission.  

      • Supplemental ERAS Application Data: The current analysis of the supplemental ERAS application for Year 2 is available on the Data and Reports page including resources to assist in understanding interview yield.  

      • For the 2025 ERAS cycle we will continue to collaborate with the community to update and standardize other areas of the MyERAS® application.  

    • Preference signaling: In 2020, the AAMC started a partnership with otolaryngology to evaluate their preference signaling program. The association’s team of researchers with expertise in selection served in a consulting role to help design the research program, analyze data, and report out results. After reporting and sharing initial findings, detailed follow-up analyses from the 2020 administration linking signals to interview and Match outcomes were published in JAMA Network Open, with the results of this work helping to inform future adoption of preference signaling in the residency application process. The AAMC, NRMP®, and NBME have also partnered to examine multiple years of signaling data across specialties as it relates to match outcomes, with longitudinal analysis planning set to begin in Fall 2023. In addition, the results of analyses examining the relationship between signaling and interview invitations in the pilot year of signaling for dermatology, internal medicine, and general surgery have been accepted for publication at the Journal of Graduate Medical Education, with results scheduled to be published on Dec 15, 2023. 

    • Program characteristics and Match® data: Since 2018, the AAMC and eight other organizations involved in the transition to residency have offered a free tool called Residency Explorer™. The Residency Explorer tool was created to empower applicants as they consider where to apply for residency. It allows applicants to compare themselves with previously matched applicants and residents entering a program and to explore many program characteristics.  

    • Virtual interviews and anti-bias training: The AAMC’s team of selection experts developed training materials and best practices to help applicants and program directors navigate virtual interviews. These free resources included strategies to help applicants prepare for virtual interviews and guidance for program directors about setting up and implementing a fair virtual interview process. These resources continue to help students and program directors. 

    • Interview Resources: The AAMC developed interview resource hubs that will help both applicants and programs prepare for residency interviews.

      • The Interview Resources for Residency Applicants page shows applicants what they can expect throughout the interview process, including tips for preparing for interviews, a guide to virtual interviews, and advice from current residents.

      • The Interview Resources for Residency Programs page helps program directors and faculty participating in interviews to prepare for, conduct, and review interviews to ensure an experience that is beneficial, equitable, and consistent for both programs and applicants.

    • Developing Foundational Competencies for Undergraduate Medical Education: The Association of American Medical Colleges (AAMC), the American Association of Colleges of Osteopathic Medicine (AACOM), and the Accreditation Council for Graduate Medical Education (ACGME) are co-sponsoring an initiative to create a common set of foundational competencies for use in undergraduate medical education programs in the United States.

      • Over the past year, the project team has focused on assembling a core working group set on drafting foundational competencies. Through early 2024, members of the public have an open call to share feedback and input on these competencies. Contribute your input by February 12 to help shape the future of undergraduate medical education. 

      • This initiative aligns with recommendations outlined in the Undergraduate Medical Education-Graduate Medical Education Review Committee (UGRC) and is part of a comprehensive effort by all three organizations to improve the transition to residency.

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    Past AAMC research and innovations

    The following projects have been discontinued or are no longer active.

    • Data to help students reduce number of applications: From 2017-2021, the AAMC provided annual data to help students anchor their initial thinking about the number of residency programs they should apply to. There is a point of diminishing returns (which varied by specialty, USMLE Step 1 score, and applicant type) where submitting one more application did not necessarily increase the student’s likelihood of entering a residency program. The association also provided data showing overall entrance rates for each specialty, the portion of applicants who enter training in another specialty, and entrance rates for applicants who fail their first attempt of the USMLE Step 1 exam. 

    • Video or virtual interviewing: The AAMC completed a multiyear Standardized Video Interview pilot project to explore how to create a uniform video interview process for residency applicants and programs. The project informed future work supporting unbiased virtual interview experiences. 

    • Application caps: Using archival data, the AAMC has been modeling the implications of different levels of application caps on the probability of entering training in general, and by applicant type, gender, and race/ethnicity. The goal of this work is to identify any unintended consequences of application caps and to use empirical evidence to inform changes to the residency application process. In 2022, this research has been extended to a broader sample of specialties, and work will continue to refine preliminary models. Despite certain limitations regarding model fit and available data, preliminary findings show that it is possible to reduce the number of applications submitted without impacting estimated entry rates, although implementing caps may disadvantage DO and IMG applicants. Further details on these preliminary findings and potential impact for differing gender and race/ethnicity groups were shared at the Learn Serve Lead meeting in 2022. 

    Recent AAMC studies on the Core EPAs

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    Resources from Academic Medicine 

    The Undergraduate to Graduate Medical Education Transition as a Systems Problem: A Root Cause Analysis 
    This article describes the work of the Undergraduate Medical Education to Graduate Medical Education Review Committee to apply a quality improvement approach and systems thinking to explore the underlying causes of dysfunction in the UME-GME transition.  

    Reimagining the Transition to Residency: A Trainee Call to Accelerated Action  
    The authors reflect on their experience as the trainee representatives on the Undergraduate Medical Education to Graduate Medical Education Review Committee. They call for the medical education community — and the Coalition member organizations in particular — to accelerate fully implementing the UGRC recommendations that were released in August 2021.   

    Blue Skies with Clouds: Envisioning the Future Ideal State and Identifying Ongoing Tensions in the UME-GME Transition  
    The authors describe how the Undergraduate Medical Education to Graduate Medical Education Review Committee envisioned an ideal state for the transition to residency, analyzed 3 persistent key tensions in the transition, and devised strategies to balance the upsides and downsides inherent to these tensions.   

    A Simulation of the Effect of Interview Caps on the National Resident Matching Program® Match in Otolaryngology  
    The authors created a simulation otolaryngology Match® to analyze the effects of interview caps. The simulation included 120 residency programs, 360 positions, and 570 applicants (each assigned a competitiveness weighted value).  

    Interview Without Harm: Reimagining Medical Training’s Financially and Environmentally Costly Interview Practices   
    Travel for medical school, residency, and fellowship interview generates carbon emissions that damage the environment and population health. The authors call for creative, structural reforms that reduce the need for such travel while increasing equity.  

    "Program Directors’ Assessment of Postgraduate Year 1 Residents’ Readiness for Graduate Medical Education: Lessons and Insights From the Association of American Medical Colleges Inaugural 2020–2021 Resident Readiness Survey" 
    A newly published abstract describes the AAMC Resident Readiness Survey (RRS) and includes evidence about the feasibility of this standardized process for program directors to provide feedback to medical schools about their graduates. 

    "Responding to Recommended Changes to the 2020–2021 Residency Recruitment Process From a Diversity, Equity, and Inclusion Perspective" 
    This article examines recommended changes to the 2020–2021 residency recruitment process from a diversity, equity, and inclusion perspective, highlighting new opportunities created by these recommendations and detailing challenges that programs must carefully navigate to ensure equity for all candidates. 

    “The Otolaryngology Residency Program Preference Signaling Experience” 
    As part of the 2021 Match®, otolaryngology applicants could participate in a preference signaling process — signaling up to five programs of particular interest at the time of application submission. In this report, the authors describe that preference signaling process, and they report that signaling markedly increased applicants’ ability to obtain interview offers from programs of particular interest, and that this effect was present across the spectrum of applicant competitiveness. 

    A Question of Scale? Generalizability of the Ottawa and Chen Scales to Render Entrustment Decisions for the Core EPAs in the Workplace 
    In this single-school study, conducted at a school participating in the Core EPAs pilot, the authors report on the results of their study comparing modified versions of the Ottawa and Chen scales on workplace-based assessment forms. 

    "Entrustment Decision Making in the Core Entrustable Professional Activities: Results of a Multi-Institutional Study" 
    In this article, the authors report on the results of the first round of theoretical entrustment decision-making at four of the participating pilot schools. 

    "Workplace-Based Entrustment Scales for the Core EPAs: A Multisite Comparison of Validity Evidence for Two Proposed Instruments Using Structured Vignettes and Trained Raters" 
    In undergraduate medical education (UME), competency-based medical education has been operationalized through the 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs). Direct observation in the workplace using rigorous, valid, reliable measures is required to inform summative decisions about graduates’ readiness for residency. The purpose of this study is to investigate the validity evidence of two proposed workplace-based entrustment scales. 

    “Development and Validation of a Machine Learning-Based Decision Support Tool for Residency Applicant Screening and Review” 
    In this article, a multidisciplinary team discusses the development and validation of a machine-learning based decision support tool for residency applicant screening and review as a way to address the growing number of applications that residency programs receive. 

    “Using Machine Learning in Residency Applicant Screening” 
    Complementing the article above, this episode of the “Academic Medicine Podcast” describes the development of a decision support tool that incorporates machine learning and the use of that tool in residency applicant screening. It also looks at the residency application process and potential ways that artificial or augmented intelligence might mitigate current challenges. 

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    Collaborations with specialties 

    Some examples of how the AAMC has supported or developed connections with other researchers and leadership organizations within the academic medicine community include:  

    • Exploring working with the Association of Professors of Gynecology and Obstetrics on modeling and evaluating the early result acceptance program as part of the AAMC’s efforts to improve the overall residency application process and contribute to evidence-informed innovations.  

    • Continuing the Careers in Medicine program’s annual Virtual Specialty Forum providing medical students exposure with specialty representatives at 21 participating specialties.  

    • Regularly maintaining connections with specialty organizations (such as OB-GYN and otolaryngology) to maintain awareness of the innovations they are researching.

    • Facilitating discussions between the undergraduate medical education and graduate medical education (GME) communities (student affairs and program directors).  

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    ERAS data supporting transition to residency research initiatives

    In addition, ERAS data are used to support a variety of internal and external research initiatives, including studies promoting diversity and equity in graduate medical education.  

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