Post-interview communication during application to orthopaedic surgery residency programs

Background: Post-interview communication from residency programs to applicants is common during the U.S. residency match process. The goals of this study were to understand the frequency and type of post-interview communication, how this communication influences applicants' ranking of programs, whether programs use "second-look" visits to gauge or to encourage applicant interest, and the financial costs to applicants of second-look visits. Methods: A post-match survey was sent to 1,198 applicants to one academic orthopaedic residency program over 2 years. The response rates were 15% in 2014 and 31% in 2015, totaling 293 responses used for analysis. Results: Sixty-four percent of applicants reported having post-interview communication with one or more programs. Seventeen percent said that communication caused them to rank the contacting program higher or to keep the program ranked as number 1. Twenty percent felt pressured to reveal their rank position, and 8% were asked to rank a program first in exchange for the program's promise to rank the applicant first. Applicants who received post-interview communication had odds that were 13.5 times higher (95% confidence interval, 6.2 to 30 times higher) of matching to the programs that contacted them. Ninety percent of applicants said that communication from a program did not change how they ranked the program with which they eventually matched. Seventeen percent were encouraged to attend second-look visits, incurring a mean cost of $600 (range, $20 to $8,000). Conclusions: Orthopaedic residency programs continue to communicate with applicants in ways that violate the National Resident Matching Program's Match Communication Code of Conduct, and they continue to encourage second-look visits. To improve the integrity of the match, we suggest that programs use no-reply e-mails to minimize influence and pressure on applicants, interviewers and applicants review the Code of Conduct on interview day and provide instructions on reporting violations to the National Resident Matching Program, all post-interview communication be directed to a standardized or neutral third party, and programs actively discourage second-look visits and stop requiring second-look visits.