Factors that influence medical students' residency program selection: a scoping review

The residency application and match process is a consequential transition in physicians' careers. Although designed to "match" applicants and programs based on mutual preferences, applicants' decisions are influenced by contextual, cultural, and personal factors. Despite its importance, the literature on how applicants evaluate and select residency programs remains fragmented and lacks a unifying conceptual framework. This scoping review synthesizes the literature to map factors influencing residency program selection.

The authors searched three databases without date restrictions, with the final search conducted in June 2026. Studies were eligible if published between January 2015 and June 2026 and reported residency selection factors among US or Canadian participants involved in the National Resident Matching Program or Canadian Resident Matching Service. Two reviewers independently screened titles/abstracts and full texts. A standardized tool captured bibliographic details, participant characteristics, methods, and reported selection factors. Data were summarized using descriptive statistics and content analysis. Factors were mapped to the Learning Environment framework, encompassing social, organizational, personal, societal, and physical and virtual space components.

Sixty-five studies published in 41 journals were included. Most studies used surveys (n = 62; 95.4%), typically author-developed. Four studies (6.2%) used interviews. Most included medical students (n = 48; 73.8%), while 25 (38.5%) included residents or fellows reflecting retrospectively. Across studies, 1,237 factors were identified (mean 19.1 per study). Social (n = 317; 25.6%), Organizational (n = 313; 25.3%), personal (n = 305; 24.7%), and societal factors (n = 255; 20.6%) were similarly reported. Physical and Virtual space factors were infrequently reported (n = 30, 2.4%).

Residency selection reflects applicants' assessments of interrelated learning environment components rather than isolated program attributes. Applying the Learning Environment framework highlights that applicants are selecting not only a training site, but a learning environment where they hope to grow personally and professionally. These findings may inform more intentional program design, recruitment strategies, and applicant decision making.