Our respondents displayed strong USMLE Step 1 performances, prolific research productivity, and the majority identified as graduates of US Allopathic medical schools. Most of our respondents reported that their medical school was in the Midwest region, which is unsurprising as this is where our institution resides. Roughly a quarter of our respondents come from a top 40 NIH research funded institution which can explain our cohort’s strong research productivity of 5.60 submitted and/or accepted publications. Exactly 27.7% of our respondents took at least one gap year before applying for this year’s cycle which may also explain our respondents’ strong research productivity. Furthermore, 13.8% of our respondents were international medical graduates and it is commonly advised for successful applicants to have greater than 2 high impact publications when applying for ophthalmology residencies per Driver et al10.
Our respondents reported an average USMLE Step 1 performance of 243.10 which is approximately the same as the nationally reported matched average of 245.03. Many of the respondents believed that they applied to more programs (13 more than average) than usual given the unique circumstances with 33% believing they attended more interviews than they would have in prior application cycles. Attendance of more interviews as virtual IV eliminated the need for domestic travel; applicants therefore could interview at programs throughout the country at the comforts of their homes. Examining Fig. 5, we report a bimodal distribution when plotting the number of interviews offered to the number of programs applied to which is similar to what Venincasa et al reported in their study in which the greatest yield of interviews invitations was at 50 and 90 programs4. Similarly, Siatkowski et al reports that at 48 applications submitted yielded the greatest amount of interview invitations1. We report from our analysis that for each applicant there seems to be the greatest yield of interview invitations at 55 and 105 programs.
Both geographical location and perceived fit were the highest rated factors in choosing programs to apply to from our respondents; however, Yousef et al in their survey study report that educational and interpersonal factors were rated by ophthalmology applicants as more important than geographical location 5 . Given a cycle of virtual interviews, one may question how well an applicant can assess for location and a residency program’s culture. Despite these obstacles, more than half of our respondents still believed that virtual interviews were sufficient in being able to adequately assess their fit with a residency program. Although a majority felt that they could assess a residency program virtually, around a quarter felt their match outcomes were negatively affected. This is similar to what Robinson et al report in a survey for applicants to cardiothoracic fellowships with a virtual interview format, also reporting 25% of applicants believed their match outcomes were negatively affected 6 . Almost all our respondents reported saving money this cycle which is best explained by the removed financial burden of domestic travel and stay. Robinson et al also conclude applicants believe that virtual interviews should be offered in the future; amongst the reasons are decreased financial burden on applicants 6 . Whilst many applicants and faculty prefer in-person interviews to virtual interviews, Quillen et al further agree that virtual interviews offer substantial cost savings and decreased travel-related stress for applicants 10 . The most frequent response to how much money was saved for this cycle was $2000 - $3000 which is consistent with what Venincasa et al found in their survey for applicants applying for ophthalmology residencies during the COVID-19 pandemic, reporting an average of $2659 saved 11 .
Roughly 40 percent of our respondents believed the elimination of away rotations negatively impacted their match outcomes. Visiting rotations are a great opportunity for an applicant to assess and work with faculty at a given residency program. Tso et al in a survey study for program directors and medical student educators across 119 accredited ophthalmology residency programs investigated the value of visiting rotations in ophthalmology; they report most program directors and medical student educators recommend applicants to complete away rotations and believe that these rotations will increase their chances at matching a host institution7. Letters of recommendation when applying to ophthalmology are touted amongst the most important factors in receiving interview invites and ultimately matching at a residency program; a survey of program directors, chairpersons, and medical student educators conducted by Nallsamy et al found for ophthalmology residency programs, 83% felt that letters of recommendation were among the most important factors considered in the resident selection process2. A quarter of our respondents reported difficulties in acquiring letters of recommendations which may have contributed to a negatively affected match outcome. This difficulty can be explained not only by the advent of the COVID-19 pandemic but also by the shortened clerkships and virtual rotations. Hammoud et al state that both shortened clerkships and the switch to virtual rotations for the 2020–2021 residency match cycle may reduce student opportunities to obtain meaningful faculty evaluations and letters of recommendations8.
A large proportion of our respondents reported an unmatched rate of 30.1 percent which is slightly higher than the national unmatch rate of 26 percent3. Allison et. al indicated in their survey the importance of higher performance on quantitative metrics, such as USMLE Step 1, as an advantage for matching12. Thus, it is unsurprising that the top factors selected by our respondents in improving one’s match outcomes were USMLE Step 1 performance, research performance, and clinical course grades. Interestingly 28.6 percent of our respondents believed that in-person interviews would have positively affected their match outcomes; this may perhaps be explained by some of our respondents believing they would perform better at an in-person interview compared to a virtual interview. Interview performance is ranked as the most important metric for evaluating and selecting ophthalmology applicants, at 95.4% per Nallasamy et al2.
Overall, the idea of open house tours to give applicant’s a better idea of a program’s facility, campus, and nearby city was well received by our respondents with more than half believing this would have influenced their final rank list. For future cycles, applicants are interested in ways to better assess a residency program and more opportunities to socialize and speak with residents. Even though half of our applicants believed they were able to adequately assess a residency program for fit, future cycles may find value in providing more opportunities to meet applicants in person and host in-person socials with residents present. Some of the applicants voiced that there should be a stronger cap on the number of programs applied to and/or number of interviews an applicant could attend. The present cycle decreased the number of interviews an applicant could attend from 20 to 18 while there were no caps put on the number of programs an applicant to apply to. Siatkowski et al1. conclude that when applying to more than 48 programs there are diminishing returns in the yield of interview invitations and overall did not affect an applicant’s match outcome1. Future cycles may have to investigate the idea of capping interviews especially with the fact that virtual interviews may become the norm as many applicants are satisfied with this setup and have a decreased financial burden in an already expensive application process.