Introduction

A primary aim of obstetrics and gynecology (Ob-Gyn) residency programs, like other residency programs, is to match the best candidates with their residency positions. The National Residency Matching Program (NRMP or Match) aims to streamline and balance the process of matching resident applicants with postgraduate training programs.1,2 NRMP rules regarding appropriate conduct for the match include specific guidelines for contact between residency candidates and programs. For example, neither program nor candidate may inform the other that they will rank each other first in order to ensure a match.

After the 2009 match, we solicited feedback about the match process from interview candidates at our program. Candidates reported they did not hear enough from us after their interviews. Our program has a policy of minimal to no communication with candidates after their interview day to avoid any potential impropriety or placing undue pressure on candidates to state their intentions. We instituted a practice change to inform candidates on their interview day to not expect a call or e-mail from us, but the candidates' feedback suggested that perhaps other programs were communicating more frequently with candidates during the prerank period.

The objective of this study was to ascertain the extent and nature of postinterview communication between Ob-Gyn programs and candidates.

Methods

We sent a self-administered web-based survey to Ob-Gyn program directors in the United States (N  =  241), querying their communication practices with candidates. The investigators developed the survey questionnaire, drawing on previous work in this field.3–5 Several questions were taken or adapted from previously published studies.3,4 A preliminary version of the survey instrument was pilot tested among a small group of obstetrician-gynecologists (within and outside the investigator's institution) with current or previous experience serving as program directors in an Ob-Gyn program. Survey questions were adapted in response to comments received during this pilot testing. A copy of the 27-question survey is provided as online supplemental material.

We obtained program directors' names, addresses, and e-mail addresses from the Council on Resident Education in Obstetrics and Gynecology and the Association of Professors in Gynecology and Obstetrics. Each program director received an e-mail invitation to participate in the anonymous survey, including a direct link to the survey website, followed by 2 e-mail reminders. Fifteen program directors declined to participate. The University of Michigan Institutional Review Board approved this study.

All data were collected electronically and archived in a secure database. Data were analyzed using descriptive statistics and qualitative analysis. Descriptive analyses were conducted to evaluate number and characteristics of program respondents and the relative distribution of responses for each question (frequencies, percentages, means, and standard deviations). Descriptive data analyses were conducted using SAS version 9.1 software (SAS Institute, Inc., Cary, NC). For qualitative data resulting from respondents' comments, we used the constant comparative method of analysis.6 Data were reviewed by 1 of the authors (PBA), an experienced researcher in medical education. After initial review, common themes were identified, coded, and confirmed by 2 additional authors (DSC and TRBJ). Distribution of these themes was subsequently tabulated.

Results

Forty percent (96 of 241) of the Ob-Gyn program directors in the United States completed the online survey. Characteristics of the responding programs are presented in table 1.

TABLE 1 Program Characteristics

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The majority of respondents (76.6%) reported that their programs initiated contact with residency candidates after interviewing them either all of the time (28.7%), most of the time (21.3%), or sometimes (26.6%). Only 23.4% reported never initiating postinterview contact with candidates. The intention and format of these communications are presented in table 2, with most programs using e-mail messages. The most common reason for communication was courtesy. Eighty-four percent of the program directors reported that candidates asked about their ranking status after the interview, with 1.1% reporting that they informed the candidate about his or her chance and 16.0% reporting that they provided a vague answer to candidate inquiries. Sixty percent of program directors informed inquiring candidates that their rank could not be revealed; however 51.5% of directors also reported that highly desirable candidates might be contacted to inform them they were ranked to match (table 3).

TABLE 2 Postinterview Communication Profile

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TABLE 3 Interaction Between Faculty/Residents and Resident Candidates During and After Interview

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TABLE 4 Comment Themes Extracted from the Survey

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Eighty-nine percent of programs facilitated events designed for candidates to socialize with faculty, residents, and other program personnel during the interview process, which provided opportunities for casual and comparative inquiry outside the formal interview schedule. Among responding programs, 52.3% reported they did not encourage postinterview socializing with candidates, and 56.7% reported they coached the faculty and residents who participated in these interviews about appropriate and inappropriate communication with candidates. Seventy-nine percent of respondents reported believing that postinterview contact with candidates either improves or has neutral impact on ranking.

Discussion

Programs and candidates each make use of interviews to determine how to rank one another; however, NRMP rules for postinterview communication between programs and candidates are interpreted variably by participants.

The NRMP policy states that

both applicants and programs may express their interest in each other; however, they shall not solicit verbal or written statements implying a commitment. It is a breach of the applicable Match Participation Agreement for either party to suggest or inform the other that placement on a rank order list is contingent upon submission of a verbal or written statement indicating ranking intentions. In addition, it is a breach of the applicable Match Participation Agreement for a program and applicant in the Matching Program to make any verbal or written contract for appointment to a concurrent year residency… prior to the Matching Program.1

Although we were unable to find reports on this issue in Ob-Gyn, in a study of recruitment processes in family medicine programs, 95% of program directors reported they had postinterview communication with candidates; and 62% stated that the expressed purpose of this was candidate recruitment.3 Ninety-eight percent reported that candidates had informed them they were highly ranked by other programs, and 60% requested comparable information from the program directors. Despite this contact, 84% of program directors were skeptical about candidates' expressed intentions, and 94% felt that the Match compelled programs to be dishonest with applicants to match their top choices.3 Similar practices have been reported for pathology programs.5 Another article laments the continued game-playing that occurs during the postinterview match period in psychiatry.8

These studies revealed that some other specialties appear to take liberties with the implementation of NRMP policies.3,5 Ob-Gyn programs strive to match the best candidates, as shown by the 51.5% of program directors in our study who informed highly desired candidates that they were ranked to match.

Our experience is that both candidates and faculty are not always sure what the rules permit and appreciate being told how our program interprets them, which is minimal, if any, postinterview contact. Still, many of the responding program directors believed that candidates and programs attempted to guess what the other was trying to communicate and that game playing was part of the routine. Program directors' free text comments reveal frustration with the postinterview, pre-Match process.

The match process is stressful for candidates, and adherence to the rules of engagement are critical to avoid programs inadvertently sending mixed messages that may pressure candidates further. Ob-Gyn residency programs are competing for a large pool of highly qualified candidates; the number of 2009 match candidates for obstetrics and gynecology programs exceeded the number of existing positions by 611 residents.1 Therefore, there does not appear to be motivation for noncompliance. Ninety-six percent of responding programs in our study reported complying with NRMP communication rules, and only 4.4% openly admitted to informing candidates of their ranking.

Although only 5.6% of the program directors thought that personal contact between candidates and programs significantly improved their ranking, 41.1% stated that it somewhat improved candidate ranking. Thus, almost half of responding program directors believe that some form of communication between the program and the candidate is helpful for the candidate's ranking. Programs primarily contacted candidates as a professional courtesy (68.1%) and to convey interest (44.9%).

Professional communication is vital to the match process, and the NRMP rules are intended to facilitate communication without increasing the pressure already felt by candidates as they interview and attempt to compose their rank lists. Perhaps a new dialogue among Ob-Gyn program directors, the NRMP, the Accreditation Council for Graduate Medical Education, and medical schools is in order to help restore trust in the original purpose of the NRMP: to protect candidates from inappropriate pressure.

A limitation of this study is the 40% response rate. However, our sample characteristics are consistent with the demographics of Ob-Gyn residency programs, and we believe our respondents represent an acceptable cross-section of the obstetric and gynecology residency programs in the U.S.

Conclusion

Postinterview communication between Ob-Gyn programs and candidates is widespread. As well intended as this communication may be, NRMP communication rules frustrate program directors in several specialties. We encourage others to explore these data so that we may resolve any concerns with the NRMP communication rules as a community. Future studies exploring candidates' experiences with the interview process for obstetrics and gynecology and other specialty residency programs will provide additional insight into communication surrounding the Match process.