Updates to the AAMC Electronic Residency Application Service application to promote efficient, effective, and fair mission-aligned resident selection

Abstract Mission-aligned selection and retention (formerly holistic review) offers an approach to selection that considers applicants’ academic metrics, attributes, and experiences to assess job-related competencies and mission-aligned characteristics. Despite residency programs’ interest in mission-aligned review, the current application context presents barriers. Designed when applicants submitted more manageable numbers of applications, the Electronic Residency Application Service (ERAS) application was not designed to support mission-aligned review amid high application volumes. It lacked sufficient structure to guide applicants to provide relevant, valuable information, leaving programs to over-rely on academic metrics rather than broader evaluations of applicants’ qualifications. It also did not provide a formal process for applicants to indicate genuine interest in a program or location, unintentionally leading programs to draw inferences and rely on informal communications, introducing inequities into the application process. To address these challenges, in 2021, the Association of American Medical Colleges (AAMC) sought to streamline and restructure the ERAS application to guide applicants to provide meaningful content and support programs’ mission-aligned review. The AAMC also leveraged the application to provide a formal, standardized process for applicants to indicate genuine interest and for programs to identify applicants interested in their programs and communities. The AAMC updated the experiences section (limited experiences to 10 and added structured experience information), added an optional impactful experiences essay question, and added geographic preferences and program signaling. Evaluation results from the 2022-2023 and 2023-2024 cycles show these changes may improve programs’ ability to conduct effective and efficient mission-aligned review and may improve fairness in the selection process. This article discusses how changes to the ERAS application seek to promote mission-aligned review and fairness in residency selection, helping programs identify capable, mission-aligned applicants. It also discusses opportunities for further research and calls for ongoing evaluation of the ERAS application by the AAMC to support continuous improvement.