Evaluating the feasibility of a normalized competitive index (NCI) to assess the competitiveness of general surgery residency

Abstract

Background

General surgery remains the predominant surgical training pathway; however, the trends in competitiveness over time are unknown. The aim of this study was to determine the feasibility of using a normalized competitive index (NCI) to assess competitiveness by analyzing 30 years of general surgery match data.

Methods

Data for general surgery programs were collected using the National Resident Matching Program (NRMP) Main Residency Match data from 1993 to 2022. Matched applicant metrics from 2007 to 2021 were collected via NRMP Charting Outcomes data. Metrics included USMLE Step 1 and 2 scores, research experiences and output, work experiences, and volunteer experiences. A competitive index was created by dividing number of positions by the match rate each year. The index was normalized, creating the NCI for trends over time. Linear regressions were performed on the NCI, match data, and applicant metrics across time.

Results

The NCI significantly differed across time (p = 0.02) with an upward-trending NCI slope; however, there were substantial fluctuations over time. The overall match rate increased over time (p<0.001), and applicants per position decreased over time (p<0.001). The USMLE Step 1 and Step 2 scores of matched applicants increased over time (R²=0.92 and R²=0.95, p < 0.001). Research output has tripled over the 2007–2021 period (2.2 vs. 7, p < 0.001). Step 2 and research output correlated with NCI (Pearson r = 0.89 and r = 0.97) but did not correlate with the match rate.

Conclusion

The competitiveness of general surgery residency programs was highly variable over time. Over the last ten years, there has been a significant increase in applicants per position and applicant metrics. The fluctuations in standard metrics of competitiveness (i.e., applicants per position, USMLE scores, research output) correlated with fluctuations in the NCI, while the match rate was relatively stable over time. This study demonstrates that the NCI may be a valuable metric for applicants to determine or predict the competitiveness of a residency program.