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    Transcript for Ask an Expert About … Transforming the Residency Application Process

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    AARON DILLARD: Hello everyone, and welcome to our latest episode of “Ask an Expert.” This is a special edition episode where we are talking to two experts about our residency application service. We made it through Match Week. This is one of the most stressful and exciting, but downright emotional times of the year for applicants and programs alike. This year alone, 44,853 applicants participated in the Main Residency Match®.

    We thought this would be a great time to bring together two leading experts in the transition to residency, to talk about how it went this year and what to expect going forward. I'm excited to introduce Dr. Jason Reminick, the CEO and founder of Thalamus, and Patrick Fritz from the Association of American Medical Colleges. He is the senior director of admissions and selection application services.

    Today, we're going to dive deeper into the transition to residency phase of the medical education continuum and specifically the AAMC Electronic Residency Application System®, otherwise known as ERAS®. Patrick, as I kick it over to you, give us a little background as to how you got here and your role here at AAMC.

    PATRICK FRITZ: Yeah. Thanks, Aaron. Hi. Patrick Fritz, senior director for admissions selection application services at the AAMC. Started my career, in, government relations and advocacy for the American Cancer Society doing lobbying on Capitol Hill in Washington, D.C. Started doing an MBA at night and got really into strategy and worked at a couple of large strategy consulting firms working with large nonprofit organizations similar to the AAMC, building IT road maps and strategic plans. And then about eight years ago came to the AAMC, where it started in earnest for a year and then moved over to, AMCAS®, which is the common application for medical schools and ran AAMC's or was the senior director for AMCAS. And then more recently, in 2022, my role was expanded to also oversee the operations for ERAS.

    So, really excited to be here. And that's my background. Thanks, Aaron.

    DILLARD: Thank you so much, Patrick. That's really great. I appreciate that, Jason. kicking it over to you, give us a little bit about your background. You were once a residency applicant, went through that entire process. Now you're working with AAMC and the residency application. Tell us a little bit about that journey and what makes it so special.

    JASON REMINICK: Yeah. So great to be here, Aaron. Thanks for having me. And to the AAMC and ERAS as well. I am Jason Reminick. I grew up on Long Island, went to the University of Pennsylvania for undergrad and majored in biochem and theater arts with a master's degree in chemistry. Maybe away to the University of Rochester, where I did my combined MD and MBA, and then eventually made my way out to Stanford in their combined pediatrics and anesthesiology program.

    And going through the whole process I had a very eventful application season, back in 2012, which we'll talk about, and that led me to Thalamus today, where I'm the CEO and founder. We’re a fully remote organization. I'm based in Nashville. we started the company out in California, in the Bay area with team members all throughout the U.S., and really excited to have come together with the AAMC in areas through strategic collaboration, which I'm excited to dive into further today.

    DILLARD: Talk to us about how Match Week went and what you guys are just happiest about right now.

    FRITZ: Sure. Thanks. Thanks, Aaron, and thanks for inviting us on here. It's been a really great cycle for us. For ERAS. This was the first year of a new application, and so we're really excited to have that launch and have it launch successfully. Heard a lot of positive feedback. This was something that we worked very closely with all members of the community on. And people are very positive about the feedback and the information that they have now, moving forward.

    DILLARD: Oh, fantastic. That that allows me to jump right into my next question. Given your new role and given the things that you've seen, how was the residency application this particular year? What are some things about this year that got you all really excited?

    FRITZ: Yeah, I think, two things. One, which I touched on earlier, the new application and I'll talk a little bit about that. And then obviously this partnership with Thalamus. We saw a huge, increase in users in Thalamus this year. And so, those were two really exciting things. So just on the application, I mentioned the new pieces of the application, seeing it come to life after years of working with the community on this, the impact that we've seen with signaling, geographic preferences, and new experiences, it's really driven an increase in holistic review and an ability to conduct holistic review, by programs.

    Also, the first time we saw a decrease in average applications, which was something very exciting. We're seeing that applicants are making more informed decisions. They have better data, they have better information, and they have better tools, to apply. On the program side, that's a reduction in burden of applications. And again, the partnership with Thalamus giving them new tools to be able to conduct holistic review and interview activity.

    DILLARD: Patrick, tell us why this collaboration was so important — the AAMC and Thalamus aligned with respect to their mission and the information that they wanted to provide to applicants.

    FRITZ: I think it was really us coming together, to meet, really driven by the community. The community here was the matchmaker, for sure. Both of us were in this space. And being together made a lot of sense for everybody — for each other, for us, but most importantly for this community.

    DILLARD: Jason, how about you? What makes this collaboration and partnership so special to Thalamus?

    REMINICK: Yeah, I think the surprise overall has been that the more and more we got to talking, the more overall mission alignment we saw amongst both organizations, when historically there was probably more competitive aspects and more competitive dynamics. And, yeah, I'd say I was at one point, probably one of the louder critical skeptics of the AAMC and that may have been mutual in some capacities as well.

    But I think that the broad and important piece here was we started talking and approaching from how can we provide value to this community? And mission jumped very close to the top of that list or at the top of that list. And at Thalamus, we've often described ourselves as a mission-driven organization. Our mission is to ensure that the right doctor ends up at the right hospital to treat the right patients. And to me, what that means is it's 3 o’clock in the morning, a patient is having the worst health care event of their life. They roll up to an emergency room. And what can the Thalamus do to ensure that that right doctor is there for them — and that can take and mean many things.

    We’ve done a lot of work looking at the broader physician workforce, particularly out in the state of California, where the representativeness of the physician workforce diverges significantly from the patient populations in that California is 40% Latino. Only 6% of doctors identify as such and is 6% black, and only 3% of doctors identify as such. And this was looking at the Thalamus data, and we were working with an organization out there to try and understand why. And what we really learned and came to appreciate was part of California's challenges is, well, it has the second most medical school spots in the country behind New York and the first most residency spots when you adjust for its 39 million population, the most populous state in the country, it drops to 46 and 26, respectively. And so, California is underserved for the number of medical school positions that it has. And so, when you look at states like New York, Florida, Ohio, Michigan, you need to look at these others and work in greater detail.

    But what we really came to appreciate with us is everything happening at the UME-GME transition affects the broader physician workforce downstream overall. And so, the more and more we focused on this mission at our organization, the more we realized that there's something else here and there's something much broader than what we're doing on a day-to-day basis.

    And so, after having discussions with our investors — and I think that was some of the overall just tension in the space too. We are a VC-backed company, but those who take the time to talk to us about that, we are backed by social impact VCs like Kapor Capital, whose investment thesis is to essentially give everyone equal opportunity regardless of what zip code they've grown up in. And that's their investment thesis and how they decide to invest in companies. And in many ways, they assess the success of their investment in our company by how much social impact there is. There's also needs to be profitability and revenue growth as well.

    But I think it's very important that the mission jumps to the front. And so, over the summer, we had discussed more — I was reading a book by Mitch and Freada Kapor, who are the main, what were the founders of Kapor Capital. Mitch Kapor was the founder of Lotus 1-2-3. They've done amazing philanthropic work and otherwise, but I was reading their book about being in the social impact space and learned about a structure, called the public benefit corporation, which came out of the state of Delaware about ten years ago, which is where Thalamus is incorporated. And it's a legal structure where a company can say that its mission is as important as its profitability.

    And a light bulb went off at our organization. Our leadership team — we had a lot of debate and discussion — and was fully supportive of it unanimously, nearly all of our investors and board of directors was as well. And we saw that there was just a real importance. And so, what this meant was we updated our legal charter to include our public benefit purpose, which is ensuring greater access to affordable, high-quality medical education and training, addressing systemic inequities in the physician workforce, and delivering better health care outcomes for patients and society.

    And so, you know, Thalamus still is the Thalamus that it's always been. But we can be very intentional about the mission, that we're striving for. And I think that's aligned incredibly well with the AAMC. We only converted to a PBC in early February, but these were the discussions we were having with the AAMC very early on in our conversations to come together as part of the strategic collaboration.

    And we realized that not only where we align in what we were trying to do for the transition to residency, but there was a lot of alignment throughout the entire journey for physician learner, for physicians, throughout their career as well. And that really excited I think both sides and has allowed us to start thinking about much broader ideas and innovation as well.

    DILLARD: Awesome. Jason, just from a perspective, I kind of want to go back just a little bit. You were once a residency applicant. Where do you see the advantage now in Thalamus being and working with AAMC to kind of bolster as well as help make this residency application a little easier in the process?

    REMINICK: Yeah. I mean, I remember still vividly, 2012, being trapped on the Upper West Side of Manhattan. Lower Manhattan was without power a week later and made it out to a program out on Long Island. And one of my co-applicants, co-interviewees that day had paid $600 for a cab ride from Staten Island out to Long Island because his car had floated away in the storm.

    And this is before the days of Uber and Lyft, and it was just — it was amazing to see that person's resiliency, grit, perseverance to make it to that interview, but also just spoke to some of the broader challenges with scheduling interviews. It's always been fast. It's always been — even back in that time, we had to write very professional emails very quickly, responding to of the 20 dates below, please pick your top three that you'd like to interview at our program and get that back.

    And then weeks later you'd hear that, oh, sorry, those three dates were filled. Please pick three more. You’d have to book travel all across the country. So now we're in the virtual interview world as well. but a lot has changed and a lot has improved. And to me, what was most exciting about the AAMC and ERAS and Thalamus coming together is, providing applicants a centralized place to coordinate and schedule their interviews.

    And we did close to over 400,000 interviews this application cycle, which is roughly close to 70% of the entire number of people submitting ranks, within the number of ranks being submitted, more broadly, to The Match® the end of the process and speaks to the number of applications and interviews that are happening around the country each and every year.

    But it's been really exciting from that perspective. And we've heard really great feedback from applicants that they're able to schedule their interviews in a more coordinated way. We expect that to be even more coordinated next year with an API that we're working on with our AAMC and ERAS colleagues that will streamline data movement between ERAS, PDWS, and Thalamus. And similarly, we expect a lot more programs will use the tool as we work to have that API go live. We had over 75% opt-in rate amongst residency and fellowship programs for ERAS this cycle. We're expecting even larger numbers next cycle. So, really exciting time for us. And I know our AAMC and ERAS colleagues, and it's just been really great to provide the community with these tools, as well as the programs working towards streamlining and optimizing this process and the overall data, which I know we're going to talk about today as well and just what comes out of that. So, it was a really great year.

    DILLARD: Awesome. And just from a lay person’s perspective, I'm not familiar with all of the various acronyms that ERAS folks may use. I know AMCAS folks have a lot of acronyms as well before they even get to, that residency part. Can you just talk to us? Just, what is an API? Just so that, I you threw that out there, I just so that folks who may not be involved in the residency field, what does that mean?

    REMINICK: Yeah. So, an API is an application program interface, which is really a way for two pieces of software to talk to each other and provide users a very streamlined experience. And so, for the programs, it's going to allow them to move data back and forth much easier. For the applicants as well, we’re building a single sign-on solution so you can log in to both systems with similar credentials.

    And the main focus and goal of all of this is to streamline the user experience and user interface as well. And so, I think that made a lot of — it will streamline the interview process, this entire application and interview process as well. And I know we also wanted to talk about really how The Match overall went. But this was — this is going to be a big step forward. And we're I know both sides are very excited about this going live next summer.

    DILLARD: Yeah. Thank you for that, Jason. That was really, really good, detailed feedback as well as a great backstory with respect to Thalamus. Patrick, with something that Jason said, I wanted to touch on a little bit more, go into a little bit deeper. How is this collaboration helping workforce beyond just what we can see? Talk to us a little bit more about just what that means for this residency space.

    FRITZ: Yeah. I think there's a perception out here that the residency application process is very transactional and ERAS has transactional history. But really, this is all about, really, premed all the way through the workforce and getting the right physicians to the right place to be successful, personally and to be successful professionally.

    And ERAS is just part of that journey where  a lot of these pieces start to start to come together. And so, at the AAMC, you know, we work closely supporting these aspiring physicians, and we work closely supporting the current physicians. And so, you know, nurturing that pipeline of physicians, that learner journey, is a really critical piece of the AAMC. And so, you know, that's one piece where ERAS is really trying to work more closely with our counterparts at the AAMC to really streamline that process and help the learner along their personal journey. And Thalamus is a piece of this solution as well — and working with them and helping them and them helping us with technology, with data, with research, with information.

    And again, with that outcome of having a successful physician, both personally and professionally, and having them at the right place, and these institutions being successful, these schools being successful, at the end of the day, Jason highlighted, the applicants wanted one place to go. They were toggling between these two systems, ERAS and Thalamus. They really wanted the one platform.

    We went out and talked to a lot of people. They like Thalamus. It made sense. And so, as Jason mentioned, with the API, Thalamus will be that one place next year. So very, very excited about that. And same for the programs — they wanted technology. They wanted technology that Thalamus had and Thalamus was already providing. They were already in this space, and they had they had a large footprint. It just made sense for us to be working together, to be able to pull the data together, to be able to work with the community together, to be able to kind of deliver these, this value, together.

    And we also knew that Thalamus, was solely in this space. They were focused on this space, they’re mission driven, they’re mission backed, and they want to make a difference. And so as we looked at a lot of vendors across this field to help us with our strategy, this one just made perfect sense. And when we started talking, it was very easy, very clear. And as we talked to the community, they really wanted this to happen as well. And so, it made it made a lot of sense.

    DILLARD: Fantastic. Thank you for that. Jason, just as a as a kind of a bridge to that. All of this data is out here, right? I mean, I think medical school students as well as applying residents can say there's just a million and one things I could read data-wise, that's just, there’s data for this is data for that, there's statistics for this, there's — you know, how is all that data helpful in building an adequate physician workforce and how can that be used so that, as Patrick said, it's not transactional. It's built and can actually be structured in more of a way that it's beneficial to its patients, from a case-by-case basis?

    REMINICK: Yeah. It's a great question, Aaron. And I'd say the data helps us measure and it helps us understand. And so, you know, you look at this year's match, for instance, and you see that pediatrics had a tougher year than usual in terms of its overall match rate. And some of that was driven by a large decrease in applications and some of that was driven by the growth of programs. And that follows a similar story that emergency medicine had, starting, now three matches ago, where there was a large number of programs about, I think 25% of the specialty that didn't end up feeling and that increase from about 200 unfilled positions that year to over 550 the year that followed.

    And we have a paper, we work with some of the emergency medicine leadership looking at why that was. And there were GME-specific reasons in that applicants, the number of applicants, had dropped by several hundred, about 800. And the number of residency spots EM over a number — that same five-year-ish period increased by 600. So you saw a delta of 1,400 positions overall, in a specialty that roughly has between 3,000 and 4,000 applicants each year. So, a pretty large swing in applicants. And one of the takeaways of the paper was that the number of applicants entering The Match, not this season that just ended, but the cycle before, was 400 less, than had entered The Match overall. And so, (1) there was a huge swing in supply and demand. And (2) you start looking at the more macroeconomic reasons. Emergency medicine had a paper that came out that said the job market was overflooded with the number of physicians in the specialty.

    COVID came about and emergency medicine went from the 14th most burned out specialty prior to COVID to now the first most burned out specialty. And you start to see these overall much broader changes in the market that are influencing what happens at the UME-GME transition. And so, data helps us study these things. EM saw a big swing, this year in, you know, the specialty saw a lot more gain in terms of how many positions filled. A lot of that was driven by an increase in DO and IMG applicants.

    And so, you know, those are not unusual market fluctuations, in a sense, that you're seeing the specialties sort of find their own place amongst the broader UME-GME transition. And I think that's the key here is that and why data is helpful is that these are markets. Each application years is its own market. Each specialty is its own market. They influence each other in all of these various ways. And so, when we start looking at data, that's important. So, geography we know is the major driver of where people match, based on research that we've done and research that we have planned for the future with the AAMC in ERAS as well, that if you grow up in a state or go to medical school in a state, you have the highest likelihood of matching in that state.

    And we've done that in anesthesia. We've done that for primary care, for peds, IM and FM. And, you know, that effect falls off as you move to the neighboring states and the neighbor’s neighbors and the neighbor’s neighbors. But based on when I spoke about about California, that's one type of market that exists. But then you look at I now live in Nashville, Tennessee — that's very different than California, Alabama, Montana, West Virginia, every state kind of has its own dynamics and market within each specialty as well. And so, why I get excited in my, you know, what I'm most excited about, about the collaboration with the AAMC is we now have essentially a population-level dataset, which will allow us to study and answer questions, which the community has been hard pressed to answer given the fragmentation that's existed, prior, particularly in the interview management space.

    Now that's there, but we can not only not only measure things in the UME-GME transition, we can look before and beyond that as well. And that's where the data really comes. and has the ability to say, yeah, how does how does this impact not only residency, fellowship training, medical school training, but also the broader physician workforce and health care and the health that people are receiving in society at large? And so that that's what I find really motivating overall.

    DILLARD: Awesome. Awesome. Well, some of the things that you just talked about with respect to some of the challenges that students can face, like, you know, growing up in a state that doesn't have certain, you know, just educational opportunities, how do you address those things? And just in a way where students and other who are applying say, hey, AAMC is addressing some of these things or addressing all of these things, what does what does that look like for ERAS?

    FRITZ: Yeah. Great question. So, when I, you know, when I started this job in 2022 and went out and talked to a lot of folks, a lot of applicants, a lot of recent applicants, you know, the two big burdens I heard, one was cost, and the other was, you know, the number of applications and transparency in the process, really. And so those were two goals that we really put out front to think through. And so, we started to address those. One is cost. You know, we are changing the — well, if you think about costs, there's really two drivers, right? There's price and there's volume. And so price, you know, one of the things we looked at was, you know, this is, it's kind of a complex system. You need a calculator to really figure everything out. There were four tiers.

    Next year, moving in, we're changing our pricing structure. We're changing it to be, $11 for the first 30 applications and $30 per application after that. Now, if you use the same current application behaviors, that's a cost savings of about 36% for the average application. Now we know applications are going down, so it should be even bigger moving forward. And then on volume I mean that's a symptom of over-applying. And we know that a lot of applicants don't need to be applying to as many programs. Not all applicants need to apply to the same number. A lot of folks want to apply to different specialties and different programs in different regions, and that's fine.

    But they need to understand really where they're applying, and they need the right information to make informed decisions about where to apply. And so, we see this partnership and the data that we have is helping to bring transparency in. Particularly, the AAMC is providing a lot of data to Residency Explorer™. That's a multiorganization collaborative tool. And excitement about some of the changes in the data that will be able to put in there to help applicants get that information free of charge and apply smartly. So, you know, we fully anticipate that not only that that changing price making an impact, but the change in volume and applicants applying to fewer applications to also impact the cost.

    One last thing on that, too. for those most in need, the AAMC is expanding their Fee Assistance Program. So that's 60% off the first 50 applications for those. And that's something that folks get at the, either before taking the MCAT®, after taking the MCAT and applying to AMCAS. We also know that there are a number of DO applicants that will be approved for fee assistance because they sought approval for MCAT or applying through AMCAS as well, and also U.S. IMGs. There's a number of U.S. IMGs who will benefit from our Fee Assistance Program. So those are three ways that we're bringing down, addressing the cost and then addressing the transparency burden.

    DILLARD: So, Patrick, just to clarify, if a person applies through the Fee Assistance Program when they were applying for AMCAS and they were approved, they do they automatically get approved when going through the residency or ERAS process or do they have to apply?

    FRITZ: That's right, that's right. Yep. Using their AAMC ID, they'll be preapproved. So, we'll know right away that they've been approved for the Fee Assistance Program based on their approval from usually maybe two or three cycles ago.

    DILLARD: But referring to the selection process, considering someone's experiences, their specific attributes as a person, where they come from, their background, their academic metrics. How does this holistic review align with the broader goal of fostering a diverse and inclusive workforce? Jason, I'll start with you and then, Patrick, I'll come back to you.

    REMINICK: Yeah. I think I think it connects to a lot of the things that we've spoken about already today in the sense that you have, this collaboration coming together, which is fostering innovation in the space, but also having the data of the broader population as well. And coming back to that mission, it's become very clear as we've had more discussions with our AAMC colleagues that, you know, the AAMC has had frameworks for holistic review before the community was talking about holistic review. Thalamus very early on — and one of the reasons why we came out with our Cortex, tool for application review and screening in 2020 at the height of the pandemic was because we wanted programs and applicants to be able to find and access better data. And then Patrick spoke about that with regard to the enhanced dataset going into Residency Explorer, so applicants have a better understanding about where they're competitive and where they should be applying.

    Similarly, for programs, you start seeing how can they get more data to not just be entirely metrics driven with regard to how they select their applicants or through filters, but rather, how do we take a much broader perspective, understanding that in many ways, our residency workforce is the future physician workforce — not many ways — it is. And so how do you help applicants and those parts of their application come through and help programs better identify that rather than having to go on scavenger hunts of data through various places. And then you can get into more, greater understanding in the applicants experiences, be they research experiences, volunteer experiences, what makes them the person that they are that is going to translate into the doctor that they are now and into the future.

    And so, having had lots of discussion with the broader community, there was a need for a more enhanced toolkit, scoring set, to participate in holistic review. And so, we launched what we call Thalamus Holistic Review. It's the next iteration of our scoring system within our software that's available to everyone, to all the programs using ERAS through this collaboration. And it allows applicants — it allows programs to look at their applicants from a competency-based perspective. They can define whatever competencies that they're looking for and to those competencies they can create questions. And from those questions, they can build various scorecards for or faculty, for residents or fellows that are also interviewing them throughout the process. And all of this data and these scores can be brought together in a shielded and screened capacity, is to eliminate conscious and unconscious bias through the process. But it allows programs to better assess distance traveled of an applicant or better understand what the alignment of that applicant looks like with that program's mission or what that program is looking to do with the educational mission of their residency and or fellowship program.

     And we've had lots of discussions with our collaborators at the AAMC and ERAS about how do we take those frameworks that the AAMC has created and been a champion of for this community and bring those tools and combine them with Thalamus Holistic Review as one use case here? The thing that immediately comes to the community is, well, what about AI and machine learning and what does that look like? And I realize that's a very hot topic for discussion given the popularity of ChatGPT. And, you know, should we use GPT to write personal statements or letters of recommendation? And there's lots of discussion there. But there are other aspects of LLMs, large language models, that allow you to just even aggregate data.

    And so, we presented, at AAMC's Learn Serve Lead conference in Seattle this past November, POC [proof of concept] that we built and are collaborating with the AAMC, looking at the fact that medical school grades are — the grades at any given medical school can be different in that some are A, B, C, D, F, some are honors, high pass, pass-fail. Some are completely pass-fail. And also, the distributions that each applicant receives in their core clerkship can vary by clerkship at each school and also across schools. And some clerkships, 50% of the students get honors and other clerkships, 10% of the students, and that can vary by medical school.

    So, for program directors to assess these through the Medical Student Performance Evaluation, which was meant to be a standardized tool to objectively assess applicants, there's a lot of variability because even the inputs to that data — and so, this is one use case that that is ripe for AI and machine learning to solve, in the sense that we ran a POC, we looked at ten medical schools. We took those medical school transcripts or ran them through an OCR [optical character recognition] model that leveraged GPT and essentially it would read the transcripts and it would pull out the grades for the clerkships. We would then review those with the human to understand if there was any that we weren't sure of in the model to better retrain the model over and over. And we were able to train it up to essentially 100% accuracy.

    And what this allows then, though, is structured data that previously was not available to the community because you can then normalize those grades both within medical schools and across medical schools to — for better comparison and objective comparison that wasn't there before. And you can then weight those and that can roll into the Thalamus Holistic Review scoring tool and otherwise. And so, there was a lot of excitement in the room. Patrick was there, I was there. We were having a really great discussion. But, you know, AI is a new tool. We're not trying to rush it out to the market. We're being very deliberate and thoughtful and intentional as to how we roll this out. We do not want this to be a black box. We're having discussions with the community. We're doing our innovative work as part of this collaboration as well. And so just taking a step back and thinking about, well, what are the implications of this? What does this mean?

    We are we are taking very strong steps toward it. But there are questions about applicants like, will I know how this is going to read my application. And so, what does that look like? And for the programs, well how do we know the data is accurate and how do we know how this is coming together?

    And we build from a very product inclusive standpoint at Thalamus, just, it's ingrained within our DNA. And then it aligns with the mission of being a public benefit corporation as well. But what steps do we take to be very intentional in terms of how do we roll this out, and what does that look like from an ethical perspective, from all these broader perspectives?

    And so, this is where I start to get excited about the collaboration as well, because we can use data to leverage and catapult a lot of this technology forward, and have these discussions and these conversations with the community to understand well, how are programs evaluating their applicants across different specialties? If I want to go into one particular specialty versus another, or are they looking for something in me that I know exists in me that I can highlight in my application?

    And similarly for programs, how do we just better find applicants that are more aligned with our mission, that want to treat our patient populations, that want to practice in the geography that our hospitals are in? And that's where this starts to get overall, to me, even more exciting because I think at the end of the day, that's what this community is looking for.

    How do I, as an applicant, know what is the best training environment for me — not necessarily the most prestigious — but the best for me to go out and become the physician that I want to be and serve the patients that I want to serve? And for the programs, regardless of the number of applications we receive, who is actually interested in our program, but not only who is interested in our program and has a shot of matching in our program, who are going to be those residents and how do we identify them? Who are going to be the stellar residents in our program because of that mission alignment? And so, I guess the theme of today overall is mission alignment, but there's a lot that technology can do to help that, along with the data, and that's where this collaboration I think really shines.

    DILLARD: Fantastic. And that dovetails perfectly into my follow up for Patrick, with this advent of AI, with all of this new technology being available to help a process that has seemingly had its challenges over the course of time, where do you — how do you see this evolving, Patrick? In terms of applicants use of the program as well as efficiency in order to actually get matched to a program that they feel best fits them both from a personal standpoint, holistically, as well as setting them up professionally to do you know, what they truly feel they can do?

    FRITZ: Yeah. No. Great. It is exciting stuff as, Jason said. And to be in that room and see the presentation, listen to the questions, hear the excitement. There's a lot of great things happening. Look, we know we need a diverse physician workforce to take care of our, you know, diverse nation. And we know the outcomes are better that way. And so, our application is going to constantly evolve to meet that need, those inputs. You saw just the changes this past year, as Jason mentioned.

    You know, this all started 20 years ago when AAMC started kind of putting this into practice, within the application. That application is going to continue to evolve with the needs. And so that's one thing that that we've said, you know, coming on board, we don't want this application to be stagnant. We want to make sure that the inputs going into these tools and things that that Jason and his team are building are really going to help get to that outcome that Jason just described, which is, you know, a good place for me, a place where I can succeed, a place where I can be successful.

    So, look, I think this stuff is going to get, you know, we've already seen 6,000-plus, I think, programs sign up just this past year before we even had the API that we talked about. Next year, it's going to be even bigger. And so, I think we're going to see a lot of positive outcomes, from the evolution of the application and the evolution of the technology coming together.

    DILLARD: That perfectly segue into us kind of wrapping things up in terms of Patrick, where you see ERAS, you know, both in the near, as well as — just not as distant future as we may think, but because the future is always right around the corner, seemingly. But you just kind of touched on some of the advantages of what AI can do in propelling the application forward to the future. What else are you looking forward to, vision-wise?

    FRITZ: Yeah. You know, look, we want to streamline the process. We want to make it less burdensome. We want to make it easier for everybody. That's something that we committed to two years ago. And we've really started down that path. And this partnership has accelerated that, right? So that's kind of where we're going.

    From the big picture, I think I talked about this a little bit, we also want to, you know, integrate and build the pathway for that learner, ERAS being a step in that process, in that pathway, along that journey. We want to create that pipeline from a premed physician or from a premed learner all the way through to the workforce. And so that's something that we're really excited about doing at the AAMC and excited about collaborating with Thalamus.

    DILLARD: Fantastic. And Jason, take us 5 to 10 years in the future from now. How do you how are you seeing Thalamus, as, you know, just being more beneficial to those who are coming into this residency space? The application, the knowledge, the data that you all are providing, collecting, you know, making people accessible to — or making accessible to people. Where do you see Thalamus in its collaboration with AAMC, working towards the future?

    REMINICK: Yeah, I think, taking it back to the beginning and how this all came together through Hurricane Sandy and just developing an understanding and an expertise in the passion and a love for this community. My team has many former program coordinators on it. I know these are — this is a process that is stressful to almost everyone involved, and it's continuing to improve.

    And we've made lots of improvements. But there's still, ways to go. And so my, broad, my grand vision here is for the applicants, providing them through that data, the way for them to make better choices, which will make the process less anxiety provoking, more fun, bringing more just enjoyment into the process. And it's enjoyable in many ways, but it's also stressful and it's part of the first transition into training in medicine, then followed by the career.

    And so how do we how do we streamline that for the applicants and how do we do the same for the programs? Because program coordinator turnover is 35% nationally right now. These are amazing heroes that are running GME, who aren't always given those accolades. But those are the amazing humans that run these processes.

    And then you have the program directors who are trying to run programs and provide care and train their residents amongst a physician workforce in the health care system that's asking for more and more demands out of them and their faculty and their interviewers. And so, taking that mission, how do we push that further down the road in collaboration with our collaborators at the AAMC and ERAS to say we now have the data.

    Let's start measuring, let's start collaborating, let's keep innovating, let's build these tools so that at the end of the day, whether you're in middle school and you want to be the world's greatest orthopedic surgeon, or a primary care doctor who's working with some of the most underserved communities in the country, or whatever that may be, an academic leader, the CEO of a health system, anywhere and everywhere in between. You can make those choices as a learner, and you can make those choices as a residency or fellowship program and a hospital to build that. And that's why mission is so important at the end of the day because mission drives passion, and our team is passionate. We see the same passion and that aligned passion with the AAMC and ERAS. And so as we start to see more and more focus on this space and competition in this space, this all drives innovation.

    But at the end of the day, it's this passion. It's this mission. It's this public benefit. It's the AAMC's educational mission. It's all of these missions and purpose that drive us into this better future of tomorrow that, at the end of the day, my greatest hope is that it will provide better health care to patients and give people better lives.

    And yes, directly that doesn't immediately happen. But all of these things align into the same process, and that ultimately drives health care in the United States and beyond. And that's what I'm in this for. So, I'm excited for the future.

    DILLARD: Well, thank you so much Patrick and Jason. I feel like ERAS, the residents, the applicants, it's in good hands with the two of you. And this collaboration with Thalamus and AAMC seems so very beneficial to everyone involved. And I hope that those who are utilizing all of these tools feel and see the benefit, you know, especially if they've gone through this process previously.

    so just again, Patrick and Jason, thank you so much for this fantastic conversation. Patrick Fritz is our senior director of admissions and selection application services with ERAS. And Dr. Jason Reminick is the CEO and founder of Thalamus. We ask that you follow us at @AAMCToday on Instagram and X, formerly known as Twitter, for updates as well.

    We hope you have a great day, and we will see you next time on the next episode of “Ask an Expert.” Take care, everyone.

    REMINICK: Thanks, Aaron.

    FRITZ: Thanks, Aaron.

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