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Reimagining residency selection: a lottery among the qualified.

Holly A Caretta-Weyer1, Benjamin Kinnear2, Maya M Hammoud3,4

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The current residency selection process hinders competency-based medical education. A modified lottery system for interviews, prioritizing competency over comparative achievements, could improve fairness and preparedness for residency training.

Keywords:
competency-based medical educationlotterypostgraduate selectionresidency selection

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Area of Science:

  • Medical Education
  • Graduate Medical Education
  • Competency-Based Education

Background:

  • Residency selection in North America impedes competency-based medical education.
  • Current selection relies on norm-referenced achievements (test scores, publications) rather than criterion-referenced competencies for patient care readiness.
  • This system incentivizes an achievement mindset, diverting focus from essential skills for residency preparedness.

Purpose of the Study:

  • To advocate for a shift in the residency selection process.
  • To facilitate a growth-oriented, competency-based undergraduate medical experience.
  • To ensure all applicants are prepared for residency training.

Main Methods:

  • Critique of current residency selection measures for being non-predictive, biased, and achievement-focused.
  • Proposal of a modified lottery system for interview positions among competency-qualified applicants.
  • Discussion of the lottery's mechanics, including student choice, equality, and special circumstances.

Main Results:

  • Current selection metrics are poor predictors of residency success and patient care readiness.
  • A modified lottery could offer a more equitable and competency-focused alternative to the current system.
  • The proposed lottery aims to align students with suitable programs based on competency and preference.

Conclusions:

  • The residency selection process requires fundamental change to support competency-based medical education.
  • A modified lottery system presents a viable alternative to enhance fairness and preparedness.
  • This approach could better align medical education with the demands of safe, high-quality patient care.