The process of securing a residency position following medical school has become increasingly arduous and complicated. The mean number of applications per applicant for US and Canadian medical school graduates has increased across all specialties in the last decade, with several specialties seeing a doubling in number of applications. For instance, from 2011 to 2019, applications per applicant increased from 15.2 to 34.8 for family medicine, from 30.5 to 61.3 for obstetrics and gynecology, and from 21.6 to 51.9 for psychiatry.¹ Similarly, the number of applications received by each program also has increased across all specialties, some by more than 200%. For example, from 2011 to 2019, the mean number of applications received by family medicine programs increased from 76 to 251 and received by psychiatry programs increased from 115 to 446.¹

A cycle involving increased numbers of applications and increased reliance on standardized testing has resulted in behavioral changes in both applicants and residency programs. Currently, senior medical students spend large amounts of time and money during the last year of medical school applying to an increasing number of programs and meeting the demands of the residency application process. Yet, in 2019, even though the ratio of first-year positions available per active US senior medical student was 1.7 (32 194 positions offered to 18 925 US applicants), the highest on record, the percentage of all US senior medical students who matched to their first-choice programs was 47.1%, the lowest on record (down from 52.6% in 2011). Furthermore, 5.8% of students did not match, an increase from 5.2% in 2011, and more than 20% of students matched to a program they ranked fourth or lower on their list.²

Meanwhile, to process the high volume of applications received, programs are likely relying more on quantitative metrics, such as United States Medical Licensing Examination (USMLE) Step 1 scores, for screening. Results of the 2018 National Resident Matching Program’s Program Director Survey showed that 94% of residency programs cited the USMLE Step 1 score/COMLEX Level 1 score as an important factor in selecting applicants to interview, an increase from 73% in 2012.³ Moreover, some programs report using minimum USMLE Step 1 scores when screening applications in an effort to reduce the number of applications to be reviewed. For example, 83% (89 of 107) of the 151 orthopedic surgery programs that responded to a survey reported use of a USMLE Step 1 minimum score when screening applications, and 53% of programs reported requiring a score greater than 230.⁴ Whether this is true for all applicants, or some, is unknown.

医学院毕业后确保居留权的过程变得越来越艰巨和复杂。在过去的十年中，所有专业的美国和加拿大医学院毕业生平均每名申请人的申请数量都有所增加，其中几个专业的申请数量翻了一番。例如，从2011年到2019年，家庭医学的每位申请人申请量从15.2增至34.8，妇产科的申请量从30.5增至61.3，精神病学的申请量从21.6增至51.9。^1个同样，每个程序在所有专业中收到的申请数量也有所增加，有的增加了200％以上。例如，从2011年到2019年，由家庭医学程序从76到251增加并且接收由精神病学程序从115增加至446接收到的应用程序的平均数¹

一个涉及申请数量增加和对标准化测试的依赖性增加的循环导致申请人和居住计划的行为发生变化。当前，高级医学院的学生在医学院的最后一年花费大量时间和金钱来申请越来越多的课程，并满足居留申请流程的要求。然而，在2019年，即使每名在职美国高级医学生提供的第一年职位比例为1.7（向18925名美国申请人提供了32194个职位），这是有记录以来的最高记录，但符合条件的所有美国高级医学学生所占的百分比首选方案的比例为47.1％，是有记录以来的最低水平（低于2011年的52.6％）。此外，有5.8％的学生不匹配，比2011年的5.2％有所增加，²

同时，为了处理收到的大量申请，程序可能会更多地依赖定量指标（例如美国医学许可考试（USMLE）步骤1分数）进行筛选。2018年全国居民匹配计划的计划总监调查结果显示，94％的居住计划将USMLE步骤1分数/ COMLEX 1级分数作为选择面试申请人的重要因素，比2012年的73％有所增加^.3此外，某些程序在筛选应用程序时报告使用最低USMLE步骤1分数，以减少要审查的应用程序数量。例如，回答了调查151个整形外科手术程序的83％（107 89）报告使用USMLE步骤1最低分数的筛选应用时，以及方案53％报告需要得分大于230 ⁴是否此是否适用于所有申请人，或某些申请人是未知的。