By Glen Bandiera

Glen Bandiera

Resident selection is one of the most critical activities that program committees do. Getting this right is key to everything from individual resident and program wellness to eventual societal impact of graduating cohorts. Furthermore, the process of applying to, and competing for, residency positions is a significant source of stress and cost for medical students. Despite the importance of this task, there was little available to programs in the way of evidence-based guidance about how to carry out selection with confidence. The impact is broad: other activities are impacted by the quality of residency program selection processes such as addressing the number of unmatched students, implementing effective career preparation and counselling strategies, and addressing the differences across various intake streams (Canadian Medical Graduates vs. International Medical Graduates; new graduates vs., re-entry; etc.). Finally, external forces such as increasing demands for social accountability and scrutiny on issues of diversity and equity weigh on program directors and postgraduate deans.

In an effort to help improve the situation, a group of interested educators at the University of Toronto undertook an extensive literature search, environmental scan and stakeholder survey to inform development of best practices for residency selection. (1) It became clear early in the process that the challenge is not solely within the domain of postgraduate medical education. Rather, opportunities exist on both sides of the undergraduate-postgraduate transition. The resulting Best Practices in Application and Selection (BPAS) report outlines 13 principles and 24 recommendations that span the process from properly informing students about their choices to ensuring appropriate procedures are in place for dealing with conflicts of interest in selection committees. Within the report there is a strong focus on objective decision-making, transparency, due process and societal responsibility. The report recommends ongoing scholarship in this area and the continued sharing of discovery and best practices. The conclusions of the report received high face validity with a few controversies in a national survey and have formed the basis for a number of national initiatives aimed at improving the selection process in Canada and beyond. (2)

1.      Bandiera G, Abrahams C, Ruetalo M, Hanson M, Nickell L, Spadafora S. Selecting future physicians with integrity: Implementing best practices in residency application and selection in a complex academic health network. Academic Medicine. 2015 Dec;90(12):1594-601. Available from: Journal of the Association of American Medical Colleges.

2.     Keith Wycliffe-Jones, MB ChB FRCGP CCFP, Glen Bandiera, MD MEd FRCPC, Nick Busing, MD CCFP FCFP, Sandra Banner, Anurag Saxena, MD FRCPC and Matt Raegele. Resident selection in Canada: What do program directors think about best practice recommendations? Can Fam Phys. 2016 Oct 1;62(2 S1):S6