Otolaryngology Residency Application Trends and Match Outcomes at a Large Academic Medical Center

Introduction: Despite significant changes over the past five years, the otolaryngology head and neck surgery (OHNS) residency application process remains highly competitive. This study assessed how applicant and medical school characteristics predict success in entering OHNS residency programs. Methods: 1,363 application files submitted to a single academic OHNS residency program during the 2019-20, 2020-21, and 2023-24 cycles were reviewed. Applicant characteristics, Step scores, medical school rankings, geographic locations, and research productivity were analyzed. T-tests and chi-square tests were used for comparative analyses, while linear modeling identified match success predictors. Results: Applications declined in the 2023-24 cycle compared to earlier cycles. Although mean Step 1 scores predicted success previously, they lost significance in 2023-24. Step 2 scores remained reliable predictors across cycles (p=0.021), with matched applicants consistently scoring higher (e.g., 2023-2024 mean: 255.8 +/-11.4 vs. 249.1 +/- 14.3, p<0.001). Research productivity increased throughout cycles, with matched applicants demonstrating higher output (e.g., 2023-2024 mean publications: 5.4 +/- 6.3 vs. 4.4 +/- 7.3, p<0.001). Research fellowships increased (26.6% in 2023-2024) and were notably linked to higher productivity, especially for applicants from lower-ranked schools. Modeling indicated that Step 2 scores, medical school rankings, and research output significantly predict match success. Conclusion: Fewer applications were received in the 2023-24 cycle, and Step 1 scores lost their predictive value, reflecting recent evaluation changes. Still, Step 2 scores and research productivity remain crucial for match success, suggesting their increasing relevance for applicants seeking OHNS residencies.