Rethinking the Match: A Proposal for Modern Matchmaking
Rethinking the Match: A Proposal for Modern Matchmaking
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DOI：
10.1097/acm.0000000000001781
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发表时间：
2018-01-01
影响因子：
7.4
通讯作者：
Dow, Alan W.
中科院分区：
文献类型：
--
作者：
Ray, Chris;Bishop, Steven E.;Dow, Alan W.
自20世纪50年代以来，国家住院医生配对计划，或“配对”，一直管理着医科学生进入住院医生的安置。这一配对是为了保护学生，因为在这个时代，住院医生的数量超过了申请者，医院迫使刚开始学业生涯的学生承诺担任住院医生的职位。然而，现在申请者的数量超过了职位，申请者申请的项目越来越多，申请者和项目的匹配成本很高。与此同时，医学教育正朝着以能力为基础的方法发展，预计美国将出现医生短缺，一些研究人员描述了“七月效应”--与新住院医师的大量进入相关的更糟糕的临床结果。在这种背景下，作者主张采用更现代、更自由的住院医师配对方法，可能更适合申请者、项目和公众的需求。他们建议允许被他们的医学院认定为已经达到毕业水平的学生可以在一年中的任何时候申请住院医师计划。常驻项目将设定自己的申请时间表，并以持续的方式延长录取期限。在学校的辅导下，学生们会根据自己的意愿接受或拒绝录取。作者认为，这种方法将更好地支持基于能力的教育，同时允许申请者和项目在选择过程中如何参与和适应方面有更多选择。该方法针对新住院医生的交错开始时间可能会减弱7月份的影响，并改善患者的预后。医科学生也可能更早进入并完成实习，从而增加医生队伍。
Since the 1950s, the National Resident Matching Program, or "the Match," has governed the placement of medical students into residencies. The Match was created to protect students in an era when residency positions outnumbered applicants and hospitals pressured students early in their academic careers to commit to a residency position. Now, however, applicants outnumber positions, applicants are applying to increasing numbers of programs, and the costs of the Match for applicants and programs are high. Meanwhile, medical education is evolving toward a competency-based approach, a U.S. physician shortage is predicted, and some researchers describe a "July effect"-worse clinical outcomes correlated with the mass entry of new residents.Against this background, the authors argue for adopting a more modern, free-market approach to residency matchmaking that might better suit the needs of applicants, programs, and the public. They propose allowing students who have been identified by their medical schools as having achieved graduation-level competency to apply to residency programs at any point during the year. Residency programs would set their own application timetables and extend offers in an ongoing fashion. Students, counseled by their schools, would accept or decline offers as desired. The authors argue this approach would better support competency-based education while allowing applicants and programs more choice regarding how they engage and adapt within the selection process. The approach's staggered start times for new residents might attenuate the July effect and improve outcomes for patients. Medical students might also enter and thereby complete residency earlier, increasing the physician workforce.