Does Residency Rank List Placement Predict Clinical Performance in Interventional Radiology Training?

RATIONALE AND OBJECTIVES: This study aimed to evaluate the correlation between Interventional Radiology (IR) trainees' clinical performance during residency and their final National Residency Matching Program (NRMP) rank order list (ROL) placement during the match application, and to identify application metrics predictive of strong clinical performance. MATERIALS AND METHODS: A retrospective review of application data for IR residents and fellows graduating from a single academic center between 2020-2025 was conducted. Metrics included United States Medical Licensing Examination (USMLE) scores, number of clinical and research experiences, peer-reviewed publications, abstracts, awards and the final placement on the ROL. A structured survey aligned with Accreditation Council for Graduate Medical Education (ACGME) milestones was designed and distributed to faculty who directly worked with each trainee but were not involved in the program's NRMP rank order list formation to evaluate their clinical performance during IR training. Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs), and a composite clinical score was calculated. Associations between application metrics, NRMP rank, and clinical performance were evaluated using Spearman correlation and univariate linear regression. RESULTS: Moderate inter-rater reliability was observed for medical knowledge (ICC=0.60, p < 0.001), procedural competence (ICC=0.50, p < 0.001), and patient care (ICC = 0.50, p = 0.004). No significant correlation was found between NRMP rank list placement and clinical performance (Spearman ρ = 0.07, p = 0.82). USMLE Step 2 score was the only significant predictor of clinical performance (β = 0.17, p = 0.01), with the greatest separation observed at a cutoff score of 239. CONCLUSION: These findings suggest that interview-driven rank placement may not reliably identify high-performing residents, whereas Step 2 scores may provide better predictive value for clinical performance during IR training.