Student academic performance factors affecting matching into first-choice residency and competitive specialties

BACKGROUND: Although specific specialties and residency programs have investigated student performance factors affecting matching, there is a paucity of information from medical schools. Furthermore, factors contributing to matching into first-choice residency have not been examined. This study aimed to identify academic performance factors affecting matching into first-choice residency and highly competitive specialties. METHODS: The authors conducted a study of 1726 graduates from their institution from 2010 to 2017 and assessed pre-/post-admission academic variables associated with matching into first choice and highly competitive specialties. RESULTS: 53.9% of graduates matched into their first choice. This was associated with passing COMLEX Level 2 CE (p = 0.01), PE (p = 0.02) on first attempt, and higher COMLEX Level 2 CE and USMLE 2 CK scores (p < 0.001 and 0.002; 14.1 and 3.9-point difference in mean scores respectively). Pre-clinical GPA (p = 0.002) and highest MCAT score (p = 0.02) were associated, however differences in means were < 1 point for both. Factors associated with matching into first choice included: MCAT (OR 0.95, 95% CI = (0.92, 0.98)), Level 2 CE score (OR = 1.01, 95% CI = (1.01, 1.02)) and passing Level 2 PE (OR = 3.68, 95% CI = (1.2, 11.28)). 12% of graduates matched into high- and 63% into low-competitiveness specialties. Matching into highly competitive specialties was associated with passing COMLEX Level 1 (p < 0.001), Level 2 CE (p < 0.001), USMLE Step 1 (p < 0.001) and Step 2 CK (p = 0.03) on first attempt. Mean scores of students matching into high- versus low-competitiveness specialties differed as follows: COMLEX Level 1 62.7 points, Level 2 CE 50.5 points, USMLE Step 1 13.6 points, Step 2 CK 7 points (all p < 0.001), as did pre-clinical GPA (2.4 points, p < 0.001). Level 1 score was the strongest predictor for matching into highly competitive specialties (OR = 1.04, 95% CI = (1.02, 1.05)). CONCLUSIONS: Licensing exam performance is important for matching into first-choice residency and into highly competitive specialties. Differences in exam scores were more pronounced for matching into highly competitive specialties than into first choice, with a larger difference in mean scores between students matching into specialties of high versus low competitiveness, than between students matching into their first- versus non first-choice residency. These results may help faculty prepare students and inform curriculum design to improve matching.