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What SHOULD residency directors use to select residents?

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  • Avatar Roentgen 
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    The discussion on another thread suggests that AOA membership may not be the marker of quality it is assumed to be, but in response another forum participant said “it is better than having no markers at all to help differentiate between applicants.”

    That got me thinking – in an ideal world, what SHOULD residency program directors use to select their residents?

    In my field (Radiology), I propose we should have applicants:

    1. take a vision test (obvious reasons)

    2. Take a hand-eye coordination test (will they be capable in interventional work?)

    3. Take an IQ test (are they smart?)

    4. Take a test to assess them on the Big Five Personality Survey Inventory (I’d prefer applicants who score high on Conscientiousness and Emotional Stability)

    I’d much rather select people on the basis of that objective information than rinky-dink one-day interviews that anyone can fake their way through.

    What you you folks use to select the best residents in your residencies?

     

     

    #150556 Reply
    Avatar Panscan 
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    No I think the current metrics such as class percentile. AOA, step 1/2 and interviews are much better than your plans.

    I don’t care if someone has a 160 iq if they sit on their butt all day. Not sure better vision makes you a better radiologist. Maybe you could do one of those spot the difference tests instead. Also I’m not sure hand eye coordination correlates with being a good IR. Probably more practice with the procedures and knowledge the disease processes involved.

    Pretty sure AOA works just fine. A few outliers do not indicate a flaw. In general it is the best students.

    #150557 Reply
    Liked by hatton1, Roentgen
    Avatar Matas 
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    The discussion on another thread suggests that AOA membership may not be the marker of quality it is assumed to be, but in response another forum participant said “it is better than having no markers at all to help differentiate between applicants.”

    That got me thinking – in an ideal world, what SHOULD residency program directors use to select their residents?

    In my field (Radiology), I propose we should have applicants:

    1. take a vision test (obvious reasons)

    2. Take a hand-eye coordination test (will they be capable in interventional work?)

    3. Take an IQ test (are they smart?)

    4. Take a test to assess them on the Big Five Personality Survey Inventory (I’d prefer applicants who score high on Conscientiousness and Emotional Stability)

    I’d much rather select people on the basis of that objective information than rinky-dink one-day interviews that anyone can fake their way through.

    What you you folks use to select the best residents in your residencies?

     

     

    Click to expand…

    I’d be reluctant to add the personality tests, especially after reading the WSJ article from Saturday about the Myers-Briggs test. The author of the article made strong claims about the lack of scientific validity of the MBTI.

    Sitting one ones butt, on the other hand, might be a valid indicator for the field, except IR (sorry! couldn’t resist!).

    In addition to the usual academic metrics, and extended 4th year rotation can allow an opportunity to assess some of the candidate’s soft skills and work ethic.

     

    #150561 Reply
    Liked by Roentgen, hatton1
    Craigy Craigy 
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    Yeah step scores and interviews seems to work fine for the top programs.  For the midrange to low-tier programs they’re just trying to put reasonably qualified warm bodies into free physician labor positions.

    AOA selection can be very political and can use relatively arbitrary metrics.  Class rank could also be useful but many schools will dumb it down greatly / outright lie about students’ rank in order to help them land better residencies.

    So yeah, step scores to see if you’re smart, interview to make sure you’re not a total weirdo.   😆

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    #150567 Reply
    Avatar JWeb 
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    This might seem very “extreme” and “outside the box” thinking, but I think residency directors should select the best medical students. . .

    #150574 Reply
    Zaphod Zaphod 
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    The discussion on another thread suggests that AOA membership may not be the marker of quality it is assumed to be, but in response another forum participant said “it is better than having no markers at all to help differentiate between applicants.”

    That got me thinking – in an ideal world, what SHOULD residency program directors use to select their residents?

    In my field (Radiology), I propose we should have applicants:

    1. take a vision test (obvious reasons)

    2. Take a hand-eye coordination test (will they be capable in interventional work?)

    3. Take an IQ test (are they smart?)

    4. Take a test to assess them on the Big Five Personality Survey Inventory (I’d prefer applicants who score high on Conscientiousness and Emotional Stability)

    I’d much rather select people on the basis of that objective information than rinky-dink one-day interviews that anyone can fake their way through.

    What you you folks use to select the best residents in your residencies?

     

     

    Click to expand…

    1. can be corected

    2. does it really matter objectively? these things can be taught to a great extent.

    3. this has been done their whole life and has happened. Board scores, etc…

    4. These are garbage and you should know were debunked decades ago. Tell me what you want and I’ll give you the personality you want, these tests are simple.

    #150575 Reply
    q-school q-school 
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    definitely not board scores.  board scores (IMO) have very little predictive power for who is a good physician, at least as I assess physicians.

    rote memorization of facts has less to do with doctoring than ever before.

    ymmv

     

     

     

    #150577 Reply
    Liked by Peds
    Avatar jacoavlu 
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    when I was a resident and students came through, my main thought was always would I want to spend 4 years with the person as my colleague, do I want this person on call with me evenings and weekends when we’re the only two people in radiology

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    #150584 Reply
    SerrateAndDominate SerrateAndDominate 
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    when I was a resident and students came through, my main thought was always would I want to spend 4 years with the person as my colleague, do I want this person on call with me evenings and weekends when we’re the only two people in radiology

    Click to expand…

    Agree with this.  My program had a lot of residency input in our ranking, which I thought was important since we dealt with people the most.  Being in path, I didn’t really care about Step scores, but I liked to see them in relation to their grades (assuming they actually had grades) and rec letters.  I was of the opinion that most people could work in my field, but they had to have the right mindset and work ethic.  We had some great applicants with great scores who we DNR’d because we didn’t want to be stuck in a room with them more than the interview day.

     

    When I got to interview applicants, I always asked them about jobs they held before med school. That was one good way to tell me a lot about them and see who wasn’t afraid to work.

    Earn everything.

    #150589 Reply
    Zaphod Zaphod 
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    definitely not board scores.  board scores (IMO) have very little predictive power for who is a good physician, at least as I assess physicians.

    rote memorization of facts has less to do with doctoring than ever before.

    ymmv

     

     

     

    Click to expand…

    I’d wager it has a moderate predictive ability but likely only at a global level, like if it were in three tiers. Theres probably a lot of difference between the lowest third, and upper third, but almost no difference within a single tier, etc…

    Part of its also the test, it doesnt test things in relation to reality of practice or anywhere close to the incidences you see in real life, but its whats testable. It does work as an IQ proxy.

    #150597 Reply
    Liked by Roentgen
    q-school q-school 
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    definitely not board scores.  board scores (IMO) have very little predictive power for who is a good physician, at least as I assess physicians.

    rote memorization of facts has less to do with doctoring than ever before.

    ymmv

     

     

     

    Click to expand…

    I’d wager it has a moderate predictive ability but likely only at a global level, like if it were in three tiers. Theres probably a lot of difference between the lowest third, and upper third, but almost no difference within a single tier, etc…

    Part of its also the test, it doesnt test things in relation to reality of practice or anywhere close to the incidences you see in real life, but its whats testable. It does work as an IQ proxy.

    Click to expand…

    it depends obviously on what you think makes a good physician.  it is at least possible that traits such as teamwork might even correlate better with lower scores than extremely higher scores.

    disagree slightly with iq proxy because the proliferation of study materials has reduced its usefulness.  also think it is more memorization than intelligence.  again jmo.  ymmv.

     

    #150602 Reply
    ENT Doc ENT Doc 
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    Ideal selection criteria should not be specified broadly and will be different for each specialty and even each program perhaps.  The earlier question of AOA revolves around what medical schools should do to provide quality transparency to residencies.  Unfortunately we don’t have better markers for things like diligence, good character, and ownership, qualities that trump step 1 scores in my opinion for safe and compassionate care.  This information, however, can be determined on rotations and constant exposure, which is why rotating students and home products (who are good) are preferred.  You’d easily take a Step 1 hit on a student who has shown diligent, hard work and takes ownership of patients.  Take more off if they’re a good person to just have around.  I think a “good hands” test at the interview is not unreasonable, but this can be practiced and gamed once the residency program’s method of assessment is known.  So it loses its validity.  Regarding IQ, I’d bet a lot of money that friends I had growing up who flunked out of college have higher IQs than the vast majority of physicians I’ve ever met.  Work ethic, grit, and determination were the great differentiators there, as they tend to be in life.  I’d rather have transparent markers for those qualities than the ones we have now (Step I, AOA), but on the average those two items do speak to work ethic IMO.

    As an aside, I’d love to see a Step 1 score regression analysis based on single, married, married with kids status in the first 2 years of med school.  Without knowing that data, someone who had 3 kids, a spouse, and who pulled off a 240 with publications makes me raise my eyebrow a lot more than the single person who got a 260.

    #150603 Reply
    Zaphod Zaphod 
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    definitely not board scores.  board scores (IMO) have very little predictive power for who is a good physician, at least as I assess physicians.

    rote memorization of facts has less to do with doctoring than ever before.

    ymmv

     

     

     

    Click to expand…

    I’d wager it has a moderate predictive ability but likely only at a global level, like if it were in three tiers. Theres probably a lot of difference between the lowest third, and upper third, but almost no difference within a single tier, etc…

    Part of its also the test, it doesnt test things in relation to reality of practice or anywhere close to the incidences you see in real life, but its whats testable. It does work as an IQ proxy.

    Click to expand…

    it depends obviously on what you think makes a good physician.  it is at least possible that traits such as teamwork might even correlate better with lower scores than extremely higher scores.

    disagree slightly with iq proxy because the proliferation of study materials has reduced its usefulness.  also think it is more memorization than intelligence.  again jmo.  ymmv.

     

    Click to expand…

    Yeah I mean just in a general sense that testing and IQ correlate. And “better” meaning only whats measureable, which are not necessarily easy things to do nor does it actually translate to reality. Sometimes testing just tests the test. I think its really a big ask and too complicated to think a simple multiple choice exam can encompass all in doctoring, theres just too many other facets. For choosing docs though, you dont have much more to go on and its really guessing at those other attributes.

    Maybe we need to be figure out a test of some nature to define and figure this stuff out, its important but thus far pretty nebulus.

     

    #150606 Reply
    Liked by Roentgen
    Craigy Craigy 
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    definitely not board scores.  board scores (IMO) have very little predictive power for who is a good physician, at least as I assess physicians.

    rote memorization of facts has less to do with doctoring than ever before.

    ymmv

    Click to expand…

    High board scores might not indicate great physicians, but low scores will probably indicate the dumber ones.   😉   😛  😆

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    #150608 Reply
    legobikes legobikes 
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    High board scores might not indicate great physicians, but low scores will probably indicate the dumber ones.

    Click to expand…

    I resemble that remark!

    #150629 Reply
    Liked by Craigy

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