Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Several factors influence the final placement of a medical student candidate on anemergency medicine (EM) residency program’s rank order list, including EM grade, standardized letterof recommendation, medical school class rank, and US Medical License Examination (USMLE) scores.We sought to determine the correlation of these parameters with a candidate’s final rank on a residencyprogram’s rank order list.

Methods: We used a retrospective cohort design to examine 129 candidate packets from an EMresidency program. Class ranks were assessed according to the instructions provided by the students’medical schools. EM grades were scored from 1 (honors) to 5 (fail). Global assessments noted on the standardized letter of recommendation (SLOR) were scored from 1 (outstanding) to 4 (good). USMLEscores were reported as the candidate’s 3-digit scores. Spearman’s rank correlation coefficient wasused to analyze data.

Results: Electronic Residency Application Service packets for 127/129 (98.4%) candidates wereexamined. The following parameters correlated positively with a candidate’s final placement on therank order list: EM grade, q¼0.379, P , 0.001; global assessment, q¼0.332, P , 0.001; and classrank, q¼0.234, P¼0.035. We found a negative correlation between final placement on the rank orderlist with both USMLE step 1 scores, q¼0.253, P¼0.006; and USMLE step 2 scores, q¼0.348, P¼0.004.

Conclusion: Higher scores on EM rotations, medical school class ranks, and SLOR globalassessments correlated with higher placements on a rank order list, whereas candidates with higherUSMLE scores had lower placements on a rank order list. However, none of the parameters examined correlated strongly with ultimate position of a candidate on the rank list, which underscores that otherfactors may influence a candidate’s final ranking. [West J Emerg Med. 2012;13(6):458–462.]