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

During the interview process for general surgery residency there is intense debate surrounding the National Resident Matching Program (NRMP) rank list. We find the process of moving an applicant marginally higher or lower on a rank list potentially arbitrary with questionable ability to predict resident performance or graduate success.

We performed a retrospective 8-year review (2010-2018) of all matched residents (n = 43) to a university program. All matched residents, including previous preliminary residents were followed until either their first position of employment, or until they attrited. All applications were reviewed for their position on the NRMP rank list and separated into three categories: rank-to-match (RTM), competitively ranked (CR), and noncompetitively ranked (NCR). Applicant data from the Electronic Residency Application Service (ERAS) was also recorded. Outcome data studied included American Board of Surgery In-training Exam (ABSITE), residency awards, administrative chief selection, grants, educational or research fellowship, disciplinary actions, coaching plans, clinical action plans, attrition, graduation, match into fellowship of choice, board passage, employment within surgery, military service, and academic practice. These measures of resident and graduate performance data were compared with NRMP rank list position using Fisher's Exact Test.

NRMP rank list position was compared with resident and graduate performance data revealing significant associations in first-year ABSITE Score (p < 0.001) and departmental awards received (p < 0.009) only. Our data reveal NRMP rank list position was not significantly associated with other metrics of resident or graduate performance including: subsequent ABSITE scores, administrative chief selection, grants, educational or research fellowship, disciplinary actions, attrition, fellowship match, board passage, employment, military service, or academic practice.

In an academic general surgery residency program, NRMP rank list position was associated only with first-year ABSITE score and receipt of departmental awards. Our data indicate that tedious and overly cautious rank list positioning of applicants may be deemphasized.