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Nature Versus Nurture: Does Residency Match Rank Order Predict Graduate Surgery Resident Performance?

Frank C Wood1, Matthew Lin2, Kenneth Stewart1

  • 1Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

Journal of Surgical Education
|November 29, 2025
PubMed
Summary

General surgery residency rank lists show limited predictive power for resident success. Applicant position on the National Resident Matching Program (NRMP) list only correlated with early exam scores and awards, not long-term outcomes.

Keywords:
Graduate PerformanceNRMP Rank ListResident PerformanceResident Success

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Area of Science:

  • Medical Education
  • Surgical Residency Training
  • Graduate Medical Education

Background:

  • The National Resident Matching Program (NRMP) rank list is a critical component of general surgery residency selection.
  • The predictive validity of NRMP rank list position for resident performance and long-term success is debated.

Purpose of the Study:

  • To investigate the association between NRMP rank list position and various metrics of resident and graduate performance in general surgery.
  • To determine if rank list placement accurately predicts future success in residency and beyond.

Main Methods:

  • Retrospective review of 8 years of matched general surgery residents (n=43) from a university program.
  • Analysis of NRMP rank list position (rank-to-match, competitively ranked, noncompetitively ranked) against comprehensive performance data.
  • Statistical comparison using Fisher's Exact Test.

Main Results:

  • NRMP rank list position was significantly associated only with first-year American Board of Surgery In-Training Exam (ABSITE) scores (p < 0.001) and departmental awards (p < 0.009).
  • No significant association was found between rank list position and subsequent ABSITE scores, chief selection, grants, fellowships, disciplinary actions, attrition, board passage, or employment.

Conclusions:

  • In academic general surgery residency, NRMP rank list position has limited predictive value, correlating only with early performance indicators.
  • Emphasis on meticulous rank list positioning may be reduced, allowing for a more holistic applicant evaluation.