Background 

Orthopaedic surgery is one of the most competitive specialties for residency applicants. For the 2021 residency match, the coronavirus-19 pandemic introduced complexity for programs and applicants because away rotations were limited and in-person interviews were cancelled. This may have changed the landscape in terms of expenses for candidates in important ways, but this topic has been insufficiently studied.

Questions/purposes 

Given that in 2021, students did not attend away rotations and all interviews were held virtually, we asked (1) What were the financial savings associated with this change? (2) Was medical school geographic region associated with differences in expenses when applying to residency?

Methods 

A retrospective, cross-sectional analysis of the 2020 and 2021 Texas Seeking Transparency in Application to Residency Dashboard database was performed. The data were derived from an online survey of a nationwide pool of applicants from 87% (123 of 141) of US allopathic medical schools upon conclusion of the match. The response percentage was 29% (521 of 1794). We believe this nationwide dataset represents the largest and most current data for this applicant group. Responses from applicants applying to orthopaedic surgery residency in the year before the COVID-19 pandemic application changes (2020) and during COVID-19 (2021) were queried and compared. After the orthopaedic surgery match, the database was evaluated for individual (application costs, away rotation expenses, and interview expenses) and total expenses for medical school seniors applying to orthopaedic surgery residency. Applicant characteristics were compared between application cycles. The 2020 to 2021 Texas Seeking Transparency in Application to Residency Dashboard database had 521 responses (n = 263 in 2020 and n = 258 in 2021) from applicants applying to orthopaedic surgery residency. Demographic and applicant characteristics were comparable between application cycles. Median expenses are reported with percentile distributions and geographic comparisons. A Mann-Whitney U test or Kruskal-Wallis H test was used to determine whether there were statistically significant differences in expenses between years and between medical school regions at a p value threshold of < 0.05.

Results 

For all applicants, the median total expenses (USD 7250 versus USD 2250), application costs (USD 2250 versus USD 1750), away rotation expenses (USD 2750 versus USD 250), and interview expenses (USD 2250 versus USD 75) declined in 2021 compared with 2020 (all p < 0.001). The median total savings in expenses for all applicants in 2021 compared with 2020 was USD 5000. In 2021, median total expenses were lower in all geographic regions with the greatest savings from applicants in the West (USD 6000); in addition, the difference in median total expenses between the geographic region with the highest total expenses and the lowest total expenses was lower in the pandemic year than it was in the year prior (USD 1000 versus USD 1500; p < 0.001). In 2021, there were differences in total expenses between the Northeast (USD 1750), West (USD 1750), and Central (USD 2750) regions (p < 0.001). From 2020 to 2021, only application fees from Northeast applicants differed (USD 2250 versus USD 1250; p < 0.001). In 2020, interview expenses were not different between all regions (USD 2250 Northeast and West versus USD 2750 Central and South; p = 0.19); similarly in 2021, interview expenses were similar between all regions (USD 75 versus USD 75; p = 0.82). Finally, in 2020, Northeast (USD 3250) and Western (USD 3250) applicants spent more for away rotations than Southern (USD 2750) and Central (USD 2250) applicants (p = 0.01). In 2021, applicants from schools in the South (USD 250) and Central (USD 250) regions spent more than their counterparts (USD 0; p = 0.028).

Conclusion 

In the COVID-19 application cycle, the median expenditures of orthopaedic residency candidates were USD 5000 lower than they were in the previous year; the difference can be attributed to the use of virtual interviews and the lack of away rotations. There are geographic implications, with applicants from Western United States medical schools potentially saving the most. Despite the financial savings during the 2021 match, further study related to the long-term success of the current application process (both for applicants and programs) is needed. The recommendation in May 2020 by the AOA Council of Orthopaedic Residency Directors (CORD) to limit the number of applications submitted by candidates with USMLE Step 1 scores greater than 235 did not result in any considerable decline in applications submitted or expenses. A better understanding of how differences in these expenses may influence our specialty’s ability to attract socioeconomically diverse candidates would be important, and we need to explore perceived and actual financial obstacles to obtaining this diversity in the application process. Finally, avenues should be explored by program directors and chairpersons to reduce the expenses of the traditional application process while maintaining recruitment of top candidates.

Level of Evidence 

Level IV, economic analysis.

中文翻译：

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冠状病毒 19 对 2020 年至 2021 年申请骨科住院医师培训的医学生费用有何影响？

背景 

骨科手术是住院医师申请者最具竞争力的专业之一。对于 2021 年住院医师培训比赛，冠状病毒 19 大流行给项目和申请者带来了复杂性，因为客场轮换有限并且面对面面试被取消。这可能在重要方面改变了候选人的费用状况，但这个话题尚未得到充分研究。

问题/目的 

鉴于 2021 年，学生不再参加外勤轮换，并且所有面试均以虚拟方式进行，我们询问 (1) 与这一变化相关的财务节省是多少？(2) 申请住院医师时，医学院的地理区域与费用差异是否相关？

方法 

对 2020 年和 2021 年德克萨斯州寻求居住申请透明度仪表板数据库进行了回顾性横断面分析。该数据来源于比赛结束后对全国 87%（141 所对抗疗法医学院中的 123 所）申请者进行的在线调查。回应率为 29%（1794 人中的 521 人）。我们相信这个全国性的数据集代表了该申请群体最大和最新的数据。我们对 COVID-19 大流行申请变更前一年（2020 年）和 COVID-19 期间（2021 年）申请骨科住院医师实习的申请人的回复进行了查询和比较。整形外科比赛结束后，数据库对申请整形外科住院医师的医学院高年级学生的个人费用（申请费用、轮换费用和面试费用）和总费用进行了评估。在申请周期之间比较申请人的特征。2020 年至 2021 年德克萨斯州寻求住院医师实习申请透明度仪表板数据库收到了申请骨科住院医师实习的申请人的 521 份回复（2020 年 n = 263 人，2021 年 n = 258 人）。申请周期之间的人口统计和申请人特征具有可比性。中位费用以百分位分布和地理比较的形式报告。使用 Mann-Whitney U 检验或 Kruskal-Wallis H 检验来确定 p 值阈值 < 0.05 时，年份之间和医学院地区之间的费用是否存在统计显着差异。

结果 

对于所有申请人而言，2021 年总费用中位数（7250 美元与 2250 美元）、申请费用（2250 美元与 1750 美元）、轮换费用（2750 美元与 250 美元）和面试费用（2250 美元与 75 美元）均有所下降与 2020 年相比（所有 p < 0.001）。与 2020 年相比，2021 年所有申请人的总费用节省中位数为 5000 美元。2021 年，所有地理区域的总费用中位数均较低，其中西方申请人节省的费用最多（6000 美元）；此外，总费用最高的地理区域和总费用最低的地理区域之间的总费用中位数差异在大流行年份低于前一年（1000 美元与 1500 美元；p < 0.001）。2021 年，东北地区（1750 美元）、西部地区（1750 美元）和中部地区（2750 美元）之间的总支出存在差异（p < 0.001）。从 2020 年到 2021 年，只有东北地区申请者的申请费有所不同（2250 美元与 1250 美元；p < 0.001）。2020 年，所有地区的面试费用没有差异（东北部和西部地区为 2250 美元，中部和南部地区为 2750 美元；p = 0.19）；同样，2021 年，所有地区的面试费用相似（75 美元与 75 美元；p = 0.82）。最后，2020 年，东北部（3250 美元）和西部（3250 美元）申请人在客场轮换上的支出高于南部（2750 美元）和中部（2250 美元）申请人（p = 0.01）。2021 年，来自南部地区（250 美元）和中部地区（250 美元）学校的申请者比其他地区学校的申请者花费更多（0 美元；p = 0.028）。

结论 

在 COVID-19 申请周期中，骨科住院医师候选人的中位支出比上一年减少了 5000 美元；差异可归因于虚拟面试的使用和缺乏客场轮换。这存在地域影响，来自美国西部医学院的申请者可能节省最多。尽管 2021 年比赛期间节省了资金，但仍需要对当前申请流程（包括申请人和项目）的长期成功进行进一步研究。AOA 骨科住院医师委员会 (CORD) 于 2020 年 5 月建议限制 USMLE 第 1 步分数高于 235 分的考生提交的申请数量，但这并没有导致提交的申请或费用大幅下降。更好地了解这些费用的差异如何影响我们专业吸引社会经济多样化候选人的能力非常重要，我们需要探索在申请过程中获得这种多样性的感知和实际财务障碍。最后，项目主管和主席应探索各种途径，以减少传统申请流程的费用，同时保持对顶尖候选人的招聘。

证据水平 

第四级，经济分析。