National Resident Matching Program Rank Order and Performance in an Internal Medicine Residency

Abstract

Objectives: Prospective first-year house staff and residency program leaders spend substantial time, effort, and expense preparing a rank order list for the National Resident Matching Program (NRMP). Previous studies have mostly shown minimal or no relation between rank order and subsequent resident performance, raising questions about the value of this process. Furthermore, no previous studies have been done with Internal Medicine residencies. As such, the purpose of this study was to compare NRMP rank order to multiple objective outcomes of an Internal Medicine residency.

Methods: A retrospective cohort of Internal Medicine residents from five consecutive graduating classes, trained between July 1, 2013 and July 31, 2020, were evaluated for five objective outcomes: Accreditation Council for Graduate Medical Education (ACGME) milestones, faculty rankings of quality, National In-Training Examination scores, chief resident attainment, and fellowship attainment. Outcomes were analyzed in relation to eight potential predictors: NRMP rank, medical school type and grades, immigration status, added qualifications, sex, age and US Medical Licensing Examination (USMLE) scores, using univariate and multivariate analyses.

Results: From a cohort of 61 residents, 56 were eligible. All eligible residents' data were included, for a participation rate of 100% (56 of 56). There were no statistically significant univariate or multivariate predictors for the endpoint of fellowship attainment. Higher USMLE scores were predictive of chief resident status in univariate analysis only. NRMP rank was significantly correlated with ACGME milestones in the univariate analysis. The multivariate analysis revealed that higher USMLE score was statistically significantly predictive of more favorable milestones, faculty ranking, and National In-Training Examination score.

Conclusions: Higher USMLE score was statistically significantly associated with multiple favorable objective residency outcomes in an Internal Medicine residency. A better NRMP rank was correlated with favorable ACGME milestones in univariate analysis, but USMLE score emerged as the strongest predictor in multivariate analysis.