A Reflection on The Match: Appreciating and Addressing the Financial Burden on Students

By Justin D. Triemstra

Match day.

Those two words can bring back a fountain of emotions for physicians.  For some, excitement and thrill. For others, anxiety or sorrow. But for most, a significant financial burden during a time of limited income. A recent discussion with a fourth year medical student reminded me of this important, yet under-recognized dilemma. One that can affect the geographical diversity of residency classes and increase disparities for students coming from low resource settings.

Since 1952, The Match has placed medical students into residency training programs. In 2017, 43,157 registrants entered The Match with 31,757 filled positions. To obtain a filled position, many students attend a significant number of interviews with the mean number of interviews attended at 12 for matched applications in 2017.1 Each interview adds to the financial burden for students with recent studies in Emergency Medicine reporting an estimated cost per trip to be about $350.2,3 With an average number of interviews attended at 12, we estimate an average medical student will spend $4200 during interview season; a significant burden for a non-salaried trainee and a number that is likely much higher for a significant number of applicants.

In addition to applying for additional loans, I have heard personal accounts from fourth year medical students who pick up second jobs to pay for interview season. For example, one student drove for Uber while another acted as an electronic medical record consultant for a hospital transitioning to EMR. Although jobs like these can add income to a student’s bottom line, is this how we, as an academic community, would like our trainees spending their time during their last year of medical school? Wouldn’t their time be better utilized focusing on experiential learning opportunities like participating in global health trips, completing research projects, preparing for intern year, or focusing on wellness initiatives? Therefore, the question for medical educators in undergraduate medical education and graduate medical education remains: how can we as an academic medical community help ease the financial burden during this essential, yet high stress period of training?

There have been a variety of recent reports describing innovative and novel techniques at reducing the cost of interviews. One study looked at videoconferencing interviews to decrease the need and subsequent financial cost of travel for interviews.4 Although, they reported that the majority of trainees were satisfied, the impersonal nature and inability for the student or resident to visibly meet and tour the institution they will be spending the next 3-7 years of their life makes this model seem insufficient for generalizability. Another study looked at collaborating with programs within the same city to decrease the need for duplicate trips.2 This innovative model is encouraging and should be considered for smaller specialties. However, it may be difficult to implement for larger training classes such as internal medicine and pediatrics.

I believe that we as an academic medical community need to continue to address this problem. Not only do these extensive costs add to the already increasing financial burden many medical students face, it also has the potential to limit geographical diversity of residency classes, decrease opportunities for students with limited resources, and potentially increase health disparities. Although a solution is not immediately clear, we should continue to explore avenues and alternatives in decreasing the cost of interview season so that students can focus solely on determining the best program for their next step of training in their career.

References:

  • National Resident Matching Program, Annual Report: 2017. Washington, DC, 2017. http://www.nrmp.org/wp-content/uploads/2017/09/Applicant-Survey-Report-2017.pdf
  • Shappell E, Fant A, Schnapp B, Craig JP, Ahn J, Babcock C, Gisondi MA (2017). A Novel Collaboration to Reduce the Travel-Related Cost of Residency Interviewing. West J Emerg Med 18(3):539-543.
  • Blackshaw AM, Watson SC, Bush JS. The Cost and Burden of the Residency Match in Emergency Medicine (2017). West J Emerg Med 18(1):169-173.
  • Healy WL and Bedair H. Videoconference Interviews for an Adult Reconstruction Fellowship: Lessons Learned (2017). J Bone Joint Surg Am 99(21):e114.

 

Justin D. Triemstra, MD, FAAP is an assistant professor of pediatrics and human development at Michigan State University College of Human Medicine and Helen DeVos Children’s Hospital.

My Classroom Is Empty: Is That a Problem?

By Kamran M. Mirza

I am no stranger to disseminating information to a group of individuals junior to me.  As a resident and fellow, I have taught many medical students in a classroom setting.  As I think back to these sessions now, I find that they were all in a setting where the student’s presence was mandatory; a review session, a laboratory etc. Nevertheless, my love for teaching grew in those sessions.  My passion for novel pedagogical approaches to pathology education led me to seek a faculty position.  I felt that there was so much I could try and achieve.  I was very excited to become pathology faculty.  What a great honor.  I couldn’t wait to meet my students.

Last fall, as I walked in to my first lecture, I found a half-empty classroom. Rows upon rows of…. no one.  Who will be the beneficiaries of my innovative theoretical pedagogy?  This was even more unusual since the lecture in question is one of the first three lectures of the M2 curriculum, typically scheduled for the first day! In the few years I have been teaching this course, I always found the entire class showing up for Day 1.Read More »

Closing the Door on the “Closing Doors” Metaphor: Reframing our Step 1 Advice

By Emily Green

Anyone who advises medical students about USMLE Step 1 will be familiar with the metaphor of “closing doors”.  Upon receiving their Step 1 score, worried students wonder if the sound they are hearing is the slamming shut of gateways to particular specialties.  The problem with the pervasive “closing doors” metaphor is that it presents career options as being either available or unavailable, with little in-between.  In a student’s mind, a score of 240 might mean that the door to a particular career is open, but a 239 means that it is closed.  Convincing students the wrongness of this thinking is a challenge.Read More »

In My Panic Zone: Teaching Feedback Seeking

By J.M. Monica van de Ridder

Teaching is something that I have been doing for over 20 years. So, in general, I don’t worry about it. I think I know what works and does not work.

Things were very different for me this time. I was worried, and I felt very much out of my ‘comfort zone’ almost in my ‘panic zone’ (Brown, 2008; Palethorpe & Wilson, 2011). I had developed an intersession for M1 and M2 medical students on how to optimize their learning processes in the clinical setting through goal setting, self-regulation, receiving and seeking feedback. The content on feedback I am familiar with, from goal-setting and self-regulation, -I assume- I know more than average.

I tried to discover my fears. What is worrying me?Read More »

Extension

By Tim Lahey

Every March I run the last required course at our medical school. It’s a three-week-long, 47-hour sprint – a sort of boot camp for professional formation. We polish clinical skills, revisit foundational sciences, let students pick from a menu of interesting tutorials, and discuss professional formation.

Students grapple with hypothetical gastrointestinal crises on scatalogically-named student teams. They resuscitate rubbery patients with various flavors of hypotension. I don a sparkly red bowtie to MC a game show called Antibiotic Jeopardy.

Throughout, we discuss the evolution of their professional identities. I ask how their idealism has changed during medical school, and every year over 60% say it has waned. We share the stories that shape us, and how they can stay true to the values that brought them to medical school in the first place. Then they hand in a tall stack of confidential essays that I reply to on nights and weekends right up until the day they speak the Hippocratic Oath. Read More »

What Diversity and Inclusion Means to Me: A Science of Learning Perspective

By Adrian K. Reynolds

Over the past few months, I’ve been on a quest to answer this one question: How does my mission to create opportunities for students to develop self-regulated, active learning1,2 skills support diversity and inclusion?

In this quest to raise my level of critical consciousness3, or, in my African American Vernacular English, to “stay woke”, I’ve asked, how do the learning opportunities I’ve provided for students foster a culture of inclusion for all, regardless of gender, ethnicity, race, age, religion, sexual orientation, socioeconomic status, origin, language, ability, or political beliefs?  Well, I thought to myself, as a Black male teacher of Spanish in the K-12 school system, then later as a college instructor of English as a Second Language (ESL), and now as an academic enhancement specialist in the medical school setting, the learning opportunities I’ve created for students from all walks of life have, I believe, reflected meaningful contributions to building a culture of diversity and inclusion.  Not being completely satisfied with this response, I continued along the path of critical self-reflection. Read More »

From Marjory Stoneman Douglas to Medical School: A Call to Action

by Zarna Patel

I cannot find the right words to describe how it felt when I read news: “School shooting at High School in Southeastern Florida.”  Despite the 239 school shootings since Sandy Hook, nothing can prepare you for the numbness of having it happen in your hometown.  The way your heart leaps into your throat, the way all sound is muted, the way debilitating fear takes hold from your head to your toes.

“Are you OK?  Tell me you’re OK?!  Please answer me!”  Never in a million years did I think I would have to send a text like that to my 16-year-old cousin, whose biggest worry last weekend was her upcoming SAT test.

Knowing how many innocent children would never return to their parent’s arms that night was paralyzing.  I couldn’t close my eyes for more than a few minutes before flashes of my old high school haunted my dreams.  The large courtyard we ate lunch in, smeared in blood.  The freshman building we loved to hate, filled with kids running away, hand raised. The large auditorium where I spent four years performing, now filled with the cries of distraught children.

Read More »