key: cord-0831931-qrx87eby authors: Quillen, David A.; Siatkowski, R. Michael; Feldon, Steven title: COVID-19 and the Ophthalmology Match date: 2020-07-10 journal: Ophthalmology DOI: 10.1016/j.ophtha.2020.07.012 sha: 05145a49b7ac55a9fc6b78b8d3a63b936bc29d10 doc_id: 831931 cord_uid: qrx87eby nan The COVID-19 pandemic has profoundly impacted ophthalmology and medical education. In an effort to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the American Academy of Ophthalmology issued a statement on March 18 , 2020 urging all ophthalmologists to immediately cease providing any treatment other than urgent or emergent care. 1 This recommendation-endorsed by every major ophthalmology organization in the United States-resulted in a 79% reduction in care, the highest decline of any medical or surgical discipline. 2 Concurrently, the Association of American Medical Colleges recommended medical schools pause all medical student clinical rotations and suggested medical students not be involved in any direct patient care. 3 The disruption was unprecedented. Medical students were unable to complete core clerkships and specialty electives at a critical time in their training. Imposed travel restrictions limited their ability to pursue away rotations, global health experiences, and academic meetings. Social distancing requirements interrupted research activities and prevented some medical students from completing United States Medical Licensing Examinations (USMLE). The dramatic reduction of activities within ophthalmology departments, coupled with the inability of medical students to engage in patient care, research, education, and outreach, have important implications for the 2020-2021 Ophthalmology Match. Several studies have explored applicant and residency program characteristics that contribute to a successful match. 4, 5, 6 These factors include: high USMLE scores, Alpha Omega Alpha membership, the presence of an ophthalmology residency program in the student's home school, the availability of ophthalmology electives. Other important considerations include honors or equivalent grades in core clinical clerkships, an outstanding medical student performance evaluation (MSPE), and supportive letters of recommendation from ophthalmology faculty. While some medical students may have had the opportunity to fulfill these expectations prior to COVID-19, others may have gaps-especially students from areas of the country hardest hit by the pandemic or those who decided to pursue ophthalmology later in their medical education. Recommendations on how applicants and residency programs can overcome matchrelated challenges associated with the COVID-19 pandemic have been proposed. 7, 8, 9 Many of these suggestions are aligned with the Coalition for Physician Accountability's Work Group (Coalition) report released on May 11, 2020. 10 The Coalition is a cross-organizational group composed of the leading organizations in medical education. In response to the COVID-19 pandemic, the Coalition issued a series of recommendations to promote consistency and fairness for all residency program applicants. Their four recommendations focus on discouraging away rotations with limited exceptions; committing to online interviews and virtual visits for all applicants; delaying the opening of the residency application process and release of the MSPE; and committing to transparency and enhanced communication among all stakeholders. The Association of University Professors of Ophthalmology (AUPO) has developed the following recommendations to mitigate the impact of COVID-19 for the 2020-2021 Ophthalmology Match cycle. Our intention is to ensure a successful residency application process by focusing on four guiding principles: safety, equity, fairness, and transparency. The AUPO acted quickly to extend the application deadline and to delay the rank list submission date by approximately one month. To reduce any perceived pressure on applicants to submit their application materials early, the AUPO directed that no applications would be visible to programs until September 1, 2020. The earliest date programs could begin to offer interview invitations was standardized to October 12, 2020. In an effort to promote safety and ensure medical students and residency programs from the most severely impacted regions are not disadvantaged by their inability to attend or host in-person interviews, all ophthalmology residency programs will conduct online rather than in-person interviews. This applies to all applicants, including local students. We realize this action will have a significant effect on the Ophthalmology Match experience. The opportunities to interview with faculty face-to-face and observe resident-faculty interactions are among the most important factors applicants utilize to develop their rank lists. 11, 12 Residency programs will need to develop creative ways to convey the intangible workplace environment characteristics that make each program special. While the vast majority of applicants and faculty strongly prefer in-person interviews, online interviews do offer substantial cost savings and decreased travel-related stress for applicants. 13 All ophthalmology residency programs will utilize the new Interview Scheduler program from SF Match to post interview dates and times and to schedule applicants. The use of a centralized interview scheduling program is intended to expand the interviewee pool and reduce last-minute cancellations by limiting the ability of applicants to hold more than one interview invitation for the same day. For the 2020-2021 application cycle only, applicants will have the ability to schedule a maximum of two online interviews per day (e.g., AM and PM) provided the interview sessions do not conflict. There will be a one-time maximum cap of 20 online interviews for each applicant. We do not anticipate this cap will adversely affect highly competitive applicants based on historic in-person interview data. In a 2018 study by Siatkowski and co-authors on the probability of success in the Ophthalmology Match, three-year outcomes data revealed the mean number of interview invitations was 9.29 with a standard deviation of 6.3. 14 The number of interview invitations ranged from 0-29 with a median of 9. The number of invitations at the 75th percentile was 14. Historically, applicants who rank more than 10 programs have a greater than 90% Ophthalmology Match success rate. 4 Applicants actively search for information to help them determine where to apply for residency training, as well as which programs to visit and rank. Those who attend a medical school without a department of ophthalmology often face difficulties in finding an advisor who is familiar with the profession or the match process. Students often utilize non-standard online resources that may or may not provide accurate information. Blogs and chat rooms often express individual experiences and contain personal impressions rather than program-specific data. While ophthalmology rankings may appear to be a useful way to differentiate programs, applicants should be cautious when interpreting the results since rankings are based solely on reputation and do not utilize statistically valid sampling or outcomes measures. 15 In an effort to provide applicants easy access to accurate program information, the AUPO has initiated a project to collect and publish core ophthalmology residency program data in a standardized fashion. The twelve data points proposed by the Match Oversight Committee and approved by the Board of Trustees are listed in Table 1 . For the first time, a uniform and accurate database for each program participating in the Ophthalmology Match will be available for applicants on a single website. Additional resources for applicants are available on the AUPO website (https://aupo.org/programs-services/medical-students). Given ongoing concerns related to travel and the fact that many applicants and residency programs are unable to attend or host away rotations, in-person away rotations are discouraged except for those applicants who do not have access to a clinical experience with an ophthalmology residency program in their home health system. Within certain specialties, away rotations may have a significant influence on where applicants rank and ultimately match. 16 The importance of away rotations in ophthalmology is unclear given that "audition" rotations are generally discouraged and available data on away rotations is limited. In a 2016 study, Winterton and co-authors reported that of the 37 survey respondents from ophthalmology, 73% completed a mean number of 1.9 away rotations; 32% of these respondents matched at their home institution or the program where they completed their away rotation. 17 There is, of course, no guarantee that students on away rotations will be issued an interview invitation; high numbers of visiting students may actually increase the competition for interview slots. The AUPO encourages all residency programs to reevaluate how they screen and rank applicants. Given the impact of COVID-19, residency programs may be unable to rely on traditional methods. For example, grading of core clinical clerkships may be limited to pass/fail with no opportunity for applicants to distinguish themselves with honors; the MSPE release date has been delayed to at least 10/21/20, more than one month after our application deadline; applicants may have encountered COVID-19 related obstacles in their pursuit of research and service. In light of these factors, residency programs may be tempted to place even greater emphasis on specific metrics like USMLE scores. It is important to acknowledge USMLE scores do not necessarily predict future resident success. 18 A recent presentation at the annual AUPO meeting showed no correlation between USMLE Step 1 scores and resident performance. 19 Furthermore, the reliance on USMLE scores disadvantages under-represented minority applicants. 20 Given our imperative to increase diversity in the field of ophthalmology, we need to employ screening and ranking methods that ensure the holistic and equitable review of all applicants. The AUPO is committed to working together with applicants and the academic ophthalmology community to ensure a successful 2020-2021 Ophthalmology Match despite the massive disruption caused by the COVID-19 pandemic. We believe the responses outlined within this document, while marking a significant departure from our traditional approach to the Ophthalmology Match, will help to ensure a safe, equitable, fair, and transparent residency application process for all stakeholders. Regular updates will be posted on the SF Match website and major developments will be distributed electronically to applicants and AUPO members. The impact of COVID-19 and these recommendations will be assessed through the SF Match survey and analysis of Ophthalmology Match participation and outcomes; the actions necessary to meet the challenges posed by the current crisis create a unique opportunity to effect changes that may benefit the match process for the long-term. Our responses to the COVID-19 pandemic are part of an ever-evolving process to serve the needs of our stakeholders and our society. The AUPO is fully committed to developing and supporting a profession that reflects the greatest integrity, diversity, and humanity. Recommendations for urgent and nonurgent patient care The Commonwealth Fund. The impact of the COVID-19 pandemic on outpatient visits Association of American Medical Colleges. Important guidelines for medical students on clinical rotations during the coronavirus (COVID-19) outbreak Ophthalmology Residency Match Outcomes for Predictors of matching in an ophthalmology residency program Correlating ophthalmology exposure in medical school to applying and matching into an ophthalmology residency Potential implications of COVID-19 for the 2020-2021 residency application cycle Proposed changes to the 2021 residency application process in the wake of COVID-19 Otolaryngology residency match during the COVID-19 pandemic. What happens next? Coalition for Physician Accountability. Final report and recommendations for medical education institutions of LCME-accredited, U.S. osteopathic, and non-U.S. medical school applicants Factors neurosurgery candidates use when choosing a residency program Applicants choice of an ophthalmology residency program Virtual surgical fellowship recruitment during COVID-19 and its implications for the resident/fellow recruitment in the future Probability of success in the ophthalmology residency match: three-year outcomes analysis of San Francisco matching program data On ophthalmology rankings COVID-19 and the Urology match: perspectives and a call to action The prevalence and cost of medical student visiting rotations Re-engineering the resident applicant selection process in ophthalmology: a literature review and recommendations for improvement Predictors of a successful ophthalmology resident. Poster presentation. AUPO annual meeting The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: a retrospective cross-sectional study