Commentary
Otolaryngology–
Increasing Competitiveness for an
Otolaryngology Residency: Where We
Are and Concerns about the Future
Alyson B. Kaplan1,2*, Katherine N. Riedy, MD1,2*, and
Kenneth M. Grundfast, MD1,2
No sponsorships or competing interests have been disclosed for this article.
Abstract
For graduating medical students, securing a residency in
otolaryngology–head and neck surgery has become exceed-
ingly difficult. This commentary explores the ways that appli-
cants and residency programs are reacting to the increasing
competitiveness in applying to, interviewing for, and match-
ing to an otolaryngology residency. The commonly held per-
ceptions of applicants are compared to perspectives held by
residency program directors and resident selection commit-
tees. Unintended consequences of the growing trend for
medical students to add a research year to their curriculum
are presented. Some cautions and suggestions about how to
improve the application and selection process are offered.
Keywords
match, residency selection, student research, medical stu-
dent education, academic otolaryngology, alternative medical
school curriculum
Received February 26, 2015; revised April 24, 2015; accepted June 9,
2015.
O
tolaryngology–head and neck surgery (Oto-HNS) has
now become one of the most sought-after careers
chosen by graduating medical students. Preliminary
Electronic Residency Application Service (ERAS) data show
that in the 2015 application cycle, there were 504 applicants
for 295 Oto-HNS residency positions. This means that more
than one-third of otolaryngology applicants did not match to
an otolaryngology residency.1 Further, in 2014, the average
United States Medical Licensing Examination (USMLE) step
1 score for successfully matched Oto-HNS applicants was 248,
the highest among all medical and surgical specialties.2 To
assess the perception of competitiveness from the students’
perspective, an online survey was disseminated to 127 third-
and fourth-year students at Boston University School of
Medicine asking them to rate the chances for matching into
various specialties; this survey revealed that 80% of students
rated matching in Oto-HNS as either ‘‘impossible’’ or ‘‘near
impossible.’’
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Head and Neck Surgery
1–3
Ó American Academy of
Otolaryngology—Head and Neck
Surgery Foundation 2015
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0194599815593734
http://otojournal.org
For the 2015 match cycle, applicants aiming to become oto-
laryngologists applied to an average of 65 programs, compared
with an average of 40 programs in 2006.1 Residency program
directors (RPDs) have had to make changes in the way that
they decide which applicants should be invited for personal
interviews. Many RPDs use ERAS software tools to set para-
meters that confine the number of applications downloaded by
setting filters that screen for minimum USMLE scores, clerk-
ship grades, citizenship, and geographic location. Applicants
whose credentials do not meet the spectrum of criteria set for
automatic download from ERAS may never have their applica-
tions seen by faculty on a selection committee.
Students are responding to the increasing competitiveness by
taking steps that they believe will make their applications seem
more impressive, for example, pursuing research, publishing
papers, and extending their time in medical school to acquire
graduate degrees such as a MBA or MPH. However, student
perceptions may not be perfectly aligned with what matters
most to selection committees, and RPDs and faculty members
at residency programs likely have varied opinions on what the
most important determinants are in the process of residency
selection. Table 1 provides an overview showing how percep-
tions of applicants may differ from the perspectives of RPDs
and faculty members involved in the selection process.
Some steps to improve the current situation are worth
considering:
1. Otolaryngology faculty members could advise stu-
dents to apply to fewer residency programs. Another
suggestion is to introduce a new step in the applica-
tion process that would require applicants to provide
a written statement explaining the reasons why they
want to match at each individual program, similar to
1
Department of Otolaryngology, Boston University School of Medicine,
Boston, Massachusetts, USA
2
Department of Otolaryngology–Head and Neck Surgery, Boston Medical
Center, Boston, Massachusetts, USA
*
These authors contributed equally to the article.
Corresponding Author:
Kenneth M. Grundfast, MD, Boston University School of Medicine, 820
Harrison Avenue, FGH Building, Suite 4005, Boston, MA 02118, USA.
Email: Kenneth.Grundfast@bmc.org
2 Otolaryngology–Head and Neck Surgery
Table 1. Competitiveness for a Residency in Otolaryngology: Perceptions of Many Medical Students and Possible Perspectives of Some
Residency Programs.
Perception of Medical Students
Securing an otolaryngology residency is becoming progressively
more difficult each year
Achieving a United States Medical Licensing Examination
(USMLE) step 1 score less than the average USMLE score of
applicants interviewed/matched in the prior match year
significantly impedes an applicant’s chance for matching and
discourages many students from applying for an otolaryngology
residency
Doing research enhances likelihood of matching
Publications are important
Having grades of Honors in clinical clerkships is of paramount
importance
Applying to a large number of residency programs enhances the
chances for matching
During the interview, dress conservatively, wear a dark suit, try
to seem perky, and be prepared to answer standard questions;
convey an interest in research and a career in academic
medicine; try to talk with and get information from current
residents
Writing thank you notes after the interview enhances the
chances for matching
the process of ‘‘secondary’’ applications used by
colleges and medical schools.3,4 Ostensibly, this
would have the effect of reducing the total number
of applications. In addition, it might help RPDs and
selection committees differentiate those applicants
who have particular reasons for wanting to match at
a specific residency program from those who are
simply applying to a huge number of programs.4
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Perspective of Residency Programs
Selecting from the pool of applicants those who will be ranked
high enough to match with a given program is becoming
increasingly difficult
Minimum USMLE step 1 scores are one of the filters set by
otolaryngology residency program coordinators as they use the
Electronic Residency Application Service (ERAS) software tool
to determine which applications will be downloaded and read/
analyzed by members of a resident selection committee
The relative importance of experience with research widely
varies among residency programs; while faculty may show some
interest in an applicant’s experience with research, in general,
faculty are more interested in determining how well an
applicant will perform in patient care than in the applicant’s
potential to accomplish meaningful research during the
residency
The relative importance of a student/applicant’s publications
widely varies among residency programs; to some extent,
faculty members view research productivity as a proxy for a
student’s ability to stay focused on a task and to complete tasks
undertaken
Residency program coordinators set ERAS filters to download
applications of students who have achieved a grade of Honors in
both internal medicine and general surgery core clerkships;
there has been grade inflation to the extent that almost every
student applying for an otolaryngology residency has mostly
Honors grades so that grades are no longer a way of
differentiating one applicant from another
Applicants are applying to too many residency programs; the glut
of applications is causing problems; some leaders are asking to
require that applicants write program-specific personal
statements explaining specifically why they want to be accepted
at each residency program to which they have applied
Interviewers are interested less in an applicant’s espoused
commitment to research or intent to pursue a career in
academic medicine than they are in eliciting evidence of
honesty, integrity, and solid work ethic; some residency
program directors have begun to use behavioral interview
techniques
A growing number of residency programs are asking interviewed
applicants not to send thank you notes because these notes
have little or no impact on how an applicant will be ranked
2. With the way in which the current selection pro-
cess is occurring, those applicants who excel in
taking standardized multiple-choice tests have the
best chance for matching. When program coordina-
tors use ERAS filters to download only the applica-
tions from students with a minimum USMLE step
1 score, the applications of some stellar young men
and women may never be seen by faculty
Kaplan et al 3

16
members. Further, it is worthwhile to note that
good test takers not only gain an advantage with 14

Number of students pursuing research

their USMLE step 1 scores but are also likely to 12
have better grades than other applicants because 10
many medical schools now use the standardized
8
shelf examinations in computation of grades for
6
clinical clerkships. Therefore, empathic students
who are astute clinicians, possess emotional intelli- 4

gence, and have exceptional manual dexterity but 2

who may not be the best test takers are put at a dis-
advantage in the selection process. Perhaps consid-
eration should be given to looking at membership
in the Gold Humanism in Medicine Honor Society
as an indicator of some applicant attributes that are
not easily discernible in numeric and grades data.
3. Currently, medical students are getting the message
that experience in research is very important when
applying for an Oto-HNS residency (see Table 1).
Surely, we do not expect all residents to become
clinician-scientists, yet the messaging about the
importance of research is prompting many students
to add a research year to their medical school curri-
culum. At Boston University School of Medicine,
the number of medical students aiming to match in
a surgical subspecialty who deferred their gradua-
tion to devote a year to research increased from 1
in 2005 to 14 in 2014 (see Figure 1). Yet, surpris-
ingly, data from Boston Medical Center shows that
only 20% of otolaryngology residents with signifi-
cant research experience prior to residency had at
least 1 publication during residency, while 100%
of residents with no research experience prior to
residency published at least 1 scientific report.
While adding a research year to the medical school
curriculum can undoubtedly be an enlightening experi-
ence, the opportunity to extend years in medical school is
not something that is available equally to all students.
Students who have limited financial resources, married
students, and students who have made commitments to
military service cannot readily extend their years in medi-
cal school. If the current trend of spending a year in
research to gain a competitive advantage continues, then,
with time, those who cannot exercise this option—likely
those who have financial constraints and come from
diverse backgrounds—will be put at a disadvantage.
A part of the folklore of otolaryngology is that otolaryn-
gologists tend to be viewed as a distinctive group of physi-
cians who love what they do, are exceptionally collegial,
and tend to be humanistic. We need to cherish the essence
of who we are, and we need to strive to make humane, con-
siderate, and fair all of the processes used in selection of
residents. We can try to discern in applicants those attri-
butes that likely are the best predictors of residency suc-
cess—integrity, perseverance, and emotional intelligence—
even though these are attributes that we have yet to figure
out how to effectively assess.
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Application Year
Figure 1. Number of students at Boston University School of
Medicine applying for a residency in a surgical subspecialty who
extended their medical school curriculum with the intention of
conducting research.
Acknowledgments
The authors would like to thank Robert Miller, MD, MBA, execu-
tive director of the American Board of Otolaryngology; Elliott
Kozin, MD, otolaryngology resident at Massachusetts Eye and Ear
Infirmary; Tabitha Fineberg, otolaryngology coordinator for educa-
tional programs at Boston Medical Center; and Ellen J. DiFiore,
registrar for the Boston University School of Medicine, for their
input and assistance in preparation of this article.
Authors’ Note
Katherine N. Riedy is a recent graduate of the BUSM and is now a
PGY-1 resident in General Internal Medicine at New York
University Langone Medical Center.
Author Contributions
Alyson B. Kaplan, design, writing, editing, final approval;
Katherine N. Riedy, design, writing, editing, final approval;
Kenneth M. Grundfast, concept, design, writing, editing, final
approval.
Disclosures
Competing interests: None.
Sponsorships: None.
Funding source: None.
References
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2. National Resident Matching Program. Charting Outcomes in the
Match: Characteristics of Applicants who Matched to Their
Preferred Specialty in the 2014 Main Residency Match.
Washington, DC: National Resident Matching Program; 2014.
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for residency training: a program’s perspective and simple solu-
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