VESS17 - Vascular Surgery Integrated Resident Selection Criteria in the Step 1 Pass/Fail Era: A National Survey of Program Directors

Objectives: Vascular surgery integrated residency (VSIR) programs are highly competitive, however, criteria for resident selection remains opaque and non-standardized. The already unclear selection criteria will be further impacted by the impending transition of the United States Medical Licensing Examination (USMLE) Step 1 from numeric scores to a binary pass/fail outcome. The purpose of this study is to investigate the historical and anticipated evaluation rubric of VSIR applicants.

Methods: This is a cross-sectional, nationwide, 59-item survey that was sent to all VSIR Program Directors (PDs). Data was analyzed using Fisher exact test if categorical, Mann-Whitney U test and Kruskal-Wallis test if ordinal.

Results: Forty out of 69 PDs (58%) responded to the survey. University-based programs constituted 85% of responders. The annual applicant number reviewed by most VSIR PDs ranged from 101 to 150 applicants (65%). Forty two percent of the responding PDs reported sole responsibility for inviting applicants to interview while 50% had a team of faculty responsible for applicant review. On a 5-point Likert scale, letters from vascular surgeons or colleagues were the most important objective criteria of selection (Table I). While work within a team structure was rated highest amongst subjective criteria (Table II). Majority of respondents (72%) currently use the Step 1 score as a primary method to screen applicants. The current top ranked selection criteria are letters from a vascular surgeon, USMLE Step 1 score and overall letters of recommendation (LOR) (Fig 1). PDs responded that that they will use USMLE Step 2 score (42%) and LOR (10%) to replace USMLE Step 1 score. The proposed top ranked selection criteria after transition of USMLE Step 1 to pass/ fail include LOR overall, Step 2 score, and LOR from a vascular surgeon (Fig 2).

Conclusions: This is the first study to evaluate the selection criteria used by PDs for VSIR. The landscape of VSIR selection criteria is shifting and increasing transparency in this methodology is essential to applicants’ understanding the selection process. LOR from vascular surgeons or colleagues of PDs are the most important factors during selection. Heretofore, USMLE Step 1 score was a first line screening variable used by the majority of VSIR programs. The transition of USMLE Step 1 to a pass/fail report will shift the attention to Step 2 scores and elevate the importance of other variables. Deconstruction of the opaque VSIR evaluation methodology is a first step towards developing a holistic candidate evaluation methodology.