Selection, mentorship, and subsequent placement of preliminary residents without a designated categorical position in an academic general surgery residency program

Academic general surgery residency programs face a reduction in clinical hours for residents at a time of expanding educational material/clinical programs. To meet these challenges, clinical staffing includes additional faculty, physician extenders, or additional residents. Categorical resident expansion is difficult but there is an ample pool of preliminary first year resident (R1) candidates every match week, and this pool is projected to increase markedly as all medical schools have increased enrollment without any real change to the demographics of available categorical residency positions. Our experience with preliminary R1s without a designated categorical position over the last 8 academic years forms the basis of this report.

The University of Colorado-Denver general surgery residency program recruits 8-12 preliminary R1s annually. Most of these are recruited on scramble day, as we found that having individual interview dates for these positions was labor-intensive and did not yield better candidates. Preliminary R1s were mentored in a systematic fashion by the program during the year to focus on career planning. Files for preliminary R1s were reviewed for demographics, medical school of origin, original prematch career goal, successful completion of the intern year, and subsequent categorical residency placement/type.

We recruited 64 preliminary R1s without a designated categorical position over the past 8 years (16 females and 48 males) with an average age of 30 years old (range 25-45 years). These preliminary R1s attended medical schools throughout the United States (West 24, South 18, Central 11, Northeast 4, or International 7). The average United States Medical Licensing Examination (USMLE) Step 1 test score was 213 (range 185-252). The majority (95%) completed their preliminary year of training or left for a categorical position during the year. Most preliminary R1s (79%) were successfully placed into categorical training programs at the end of the year, with 23% ultimately receiving categorical training at our institution. Four did not complete their preliminary training year due to medical leave or unsatisfactory performance. The categorical positions preliminary R1s obtained include general surgery (n = 7, 15%), surgical subspecialties (n = 31, 65%), and nonsurgical subspecialties (n = 10, 20%). Ultimately, 14 (29%) of preliminary R1s who matched after 1 year did so in their fields of original interest.

A symbiotic relationship can exist between a general surgery residency program and preliminary R1s. An approach that focuses on scramble day recruitment, frequent mentorship meetings, and an active role in secondary placement results in successful placement into categorical positions for the vast majority. In that regard, we would argue that we have provided equal career mentorship to these graduated students in comparison with their medical schools of origin.