Match Day Reflections: What This Year Taught Program Directors

Episode Summary

Residency recruitment is often discussed in terms of outcomes, match rates, fill rates, and competitiveness. Less often is it examined as a continuous, year-round process shaped by strategy, signaling, and evolving applicant behavior.

In this episode of PDs@SEA, Dr. Marianne Chen and Dr. Bryan Mahoney reflect on the most recent Match, sharing initial reactions and what this recruitment cycle reveals about the current state of anesthesiology training. From the sheer volume of work behind recruitment to the increasing competitiveness of the specialty, the conversation highlights how both programs and applicants are adapting in real time.

The discussion explores how signaling continues to shape application review and match outcomes, including emerging trends in gold versus silver signals and the unintended consequences of applicants “gaming” the system. The episode also examines shifts in the applicant pool, including broader interests, growing demand for away rotations, and evolving expectations around career flexibility, innovation, and global health.

These themes are grounded in the operational realities of recruitment: how programs screen applicants with limited data, how away rotations influence selection, and how program directors refine their internal processes over time. The conversation also offers practical insight for new program directors, emphasizing rank list integrity, iterative improvement, and the long-term value of investing deeply in recruitment.

The episode closes with advice for applicants, including the importance of meaningful exposure to anesthesiology and a realistic understanding of the specialty’s day-to-day demands, particularly the unpredictability of clinical work. Taken together, this discussion captures a specialty in transition, where demand is high, systems are evolving, and both applicants and educators are recalibrating expectations.

Key Takeaways From This Episode

• The anesthesiology match remains highly competitive, with strong applicant pools and high fill rates across programs.
• Signaling continues to improve application review and match alignment, with increasing differentiation between gold and silver signals.
• Applicant behavior is evolving, including strategic use of signals and broader interests beyond traditional clinical pathways.
• Away rotations remain the most reliable way to assess fit, while also introducing access and equity challenges.
• Recruitment is a year-round effort, and early, intentional investment in the process improves downstream outcomes.
• There is no single “correct” selection algorithm; programs must define success based on their own priorities and iterate over time.
• Applicants benefit from deeper exposure to anesthesiology, including understanding the unpredictability of clinical practice.

Especially Useful For

Program directors, associate program directors, residency leadership teams, department chairs, and clinician-educators focused on recruitment strategy and the evolving anesthesiology workforce pipeline.

Related Episodes

• The Truth About Signaling, Letters of Intent, and The Match: A PD’s Unfiltered Guide
  A practical deep dive into signaling strategy, applicant behavior, and how programs interpret interest during the match process.
• So the Applications Just Dropped: How Program Directors Actually Read Them
  A behind-the-scenes look at how PDs screen applications, manage volume, and make interview decisions.

Transcript

Marianne Chen, MD 0:12

Hello, everybody. Welcome to the next episode of Program Directors at C. We are here today and excited to talk about our recent match and all of the new residents that we're welcoming into our specialty. First of all, a big congratulations to everybody who matched. We're excited to have you join us. And also congratulations to all the program directors. I know it's a big feat. It's a lot of work for everybody to put into recruitment. And I'm sure we're all excited that we all had such fantastic matches this year. Brian, I'd love to hear. What were your initial thoughts after you got your match results and thinking about this last recruitment cycle?

Bryan Mahoney, MD 0:49

Well, hearing you talk about the work makes me think about a question I asked my chiefs at the end of the chief year. I say, hey, what's the biggest surprise that you guys had in the experience of being chief residents in every single year? They say, we had no idea how much work went into recruiting every year because we, you know, we have them involved and they're always shocked. I even warned them at the beginning it's going to be a huge component. And they're shocked. So it is a ton of work. I'm going to surprise you with a question we didn't think about. I make a little presentation about my new residence. Are you going to use AI next year to help you make your new class presentation?

Marianne Chen, MD 1:24

Great question. I think I'm trying to use AI in as many ways as I can and try to incorporate it, really letting our my coordinator team also think about how we integrate AI and how we're going to introduce our residents and just in our the ways we do work in the residency program. But love that idea. Love having, you know, all these announcements made with AI would be so wonderful to see all the programs, you know, make their match announcements.

Bryan Mahoney, MD 1:50

Yeah, it's a full-day process for me because I want to really unveil the new class in a flashy way and make them feel welcome. But eight hours every year, I could probably get that to AI. Anyway, what are your initial big impressions after another uh blockbuster year for anesthesia recruiting?

Marianne Chen, MD 2:09

Yeah. I think everybody, when I tell folks that have been in anesthesia for a long time, you know, new faculty that we filled all of our spots in anesthesiology for the categorical PGY1 positions and most of the PGY2 positions, everybody's just really shocked, right? Like it's so fabulous that we're getting these great applicants, we're filling all our spots and that our specialty is growing. Um and it's just, I think, good news for us as a specialty and as we think about how our field is expanding. We had a great match. We're really excited for all of the applicants we matched. I think we've talked about this before in previous episodes, but the signaling is is working, right? I think that it really helped as we narrow down candidates to interview, but I also think that's being reflected in how we're matching and we're, you know, truly matching people at the top of our list that have shown interest in our program and that we've felt would be a good fit and a, you know, a good place for them to come train with us. But we're your nickel thoughts.

Bryan Mahoney, MD 3:09

Well, I know the candidates are so I'm about the signals. If any of them are listening, listen, guys, it really does help us do a holistic review of your application. When I'm looking at hundreds of signals versus 2,000 applications without signals at the peak, I really can take a deep dive into a lot more applications. An entire committee, selection committee can do that. So I also like the fact that on the front end we're able to spend a lot more time parsing through people, looking throughout the entirety of their application and finding people we think are going to be a good fit to really take advantage of what is a limited resource for interviews. But yeah, the signals are working. I love the system. I think most program directors like the reduction in the applications they're getting and in the ability to see who's really interested. You mentioned that the categorical spots all filled anesthesias and you know big demand, but those reserve spots, those PGY2 spots, were not totally filled. One of my colleagues here in the New York area took him a while to realize that these spots that were once not just gold, they were platinum, they were really, really hard to come by, these reserve spots, crazy competitive, are actually less competitive now. And for the last few years, I have been telling candidates that I have the perception that it's ironically enough, easier to match into a reserve spot. I think it's indicative of the fact that so many programs are expanding and there are so many new programs coming online, and the pool of people who can apply are limited to those who are either currently in training in some other specialty or just doing an intern year with no plans beyond that. So a lot of the people who are going unmatched over the last few years didn't skip a beat, didn't lose any time. Uh, they went unmatched last year and they were able to jump right into a reserved anesthesia position. A lot of people I mentored were able to do that. Are you working with medical students? Are you mentoring people who went unmatched or looking to find reserve positions and helping them?

Marianne Chen, MD 5:11

We have a few that will do the prelim surgery internear at Stanford. And so they'll meet with myself, other program leadership to talk about the approach to applying to our spots. You know, do I apply also to categorical and advanced spots and maybe take a year off, do a year of research or repeat interneer? And so I get a lot of emails and questions from from also residents who may be having a change of thought about what they want to do and so are starting their inter year and halfway through are, you know, thinking about either, you know, going into anesthesia. Maybe this is not the field for me, as well as folks that, you know, have completed a pediatric residency, have completed a medicine residency, and now are like, I actually want to do critical care, or you know, I think that anesthesia may be more in line with my career goals. So I definitely hear a lot from them. We have not offered an R spot at Stanford for a few years now. So I think that, you know, we're happy to mentor them and kind of give them advice, but don't necessarily always have spots for them within our own our within our home program at Stanford.

Bryan Mahoney, MD 6:15

This year I have been telling them again that over the last few years I found those R spots to be less competitive. I'm not sure if it's gonna remain the case. If I had to imagine based on what I've seen, I think we've peaked in terms of the expansion of new programs and spots, but I could be wrong. So I always do give them the caveat that, you know, we may have peaked and it might start slowly drifting towards those being much, much more difficult. But even though we've peaked, I think we're still gonna continue to see a lot of available our spots next year and the year afterwards as we really struggle to try to catch up with training enough anesthesiologists to fill the gap that we have for the amount of patient care that's out there. So this has been year three of the tiered signals, if I'm correct, and year four of signals. Am I is my math right? Is that three and four correct or is it two and three?

Marianne Chen, MD 7:06

I started this. This is my third match where we had tiered. So yeah, you're right. Three years of tiered and then four of just signals.

Bryan Mahoney, MD 7:14

Are you gonna change anything based on what you saw this year over the last three years? Do you foresee any changes in your approach to screening, interviewing, ranking?

Marianne Chen, MD 7:25

So uh this year, as I looked at our data and our match data, we matched a much higher percentage of golds than we've had in previous years. And our approach to signaling since we started was to look at gold and silvers pretty similarly. We didn't necessarily differentiate, but I think that as people are learning more about signals, that programs and applicants are both understanding signals better, we will probably move towards just focusing on our gold signals first and and and actually looking that at them differently than our silver signals next year and seeing how that goes. Because we over the trend that I've noticed over three years is that you know we were kind of matching half, half gold, silver, and then a little bit more gold like 70, 30. And this year we matched like 90% gold and 10% silver. So the trend is I think if you know you're really interested in us, that's you're giving us a gold signal, and that means that you want to you want to come to our program. And you know, that I'm realizing over the with this trend that there is a difference between the gold and silver that we should be looking at more carefully.

Bryan Mahoney, MD 8:29

I found the same thing. I might have recruited 100% gold. I didn't look at the numbers too carefully, but it might have been 100%. However, this year, PDs and the AACPD has talked about some concerns with the applicants looking at interview rates based on signals sent to certain programs. And so I think the term that came up at our last meeting is they're moneyballing it. They're not actually using the signals necessarily with the programs in which they have the most interest, but rather they're saying, well, you know, I'm gonna use a silver for this one because they had a much higher interview hit rate with silvers than this other program, even though I'm more interested because I want to maximize the number of interviews I get. I think that's a really, really wrong-headed approach for the applicants. But it also makes me concerned about maybe having a different approach to gold and silvers. Do you have a different approach, not just in terms of um favoring the gold signals? But let's say that you select a bunch of applicants from the gold pool and you have interview spots that you want to give to silvers. Do you look at the silver signal applicants differently in terms of how you decide who's gonna get an interview than you do with the golds?

Marianne Chen, MD 9:39

I think we would look at that the same. I don't think we would look at them differently. I think maybe we would we've always just looked at our gold and silver as one big batch of applications together. But I think next year we might look at our gold first, kind of see how the how they're scoring based on, you know, our holistic review and then go to the silver and and then decide, you know, where our score cut of his, like what what the breakdown is, and and be a little bit more you know thoughtful of of the gold versus silver versus in the past it would just be one big batch of applicants, gold or silver, and we would invite based on their score, not necessarily determining if they're a gold or a silver signal.

Bryan Mahoney, MD 10:16

Well, I just criticized the money ball approach, but I actually think I take it a little bit with my silver signals. With the silvers, I actually screen out the most highly competitive silver candidates, thinking I'm already your number six, you're just a lights out candidate. If there's five places you like more than me, I'm sure I can flip you about a couple of them, but probably not all five. So if you're this competitive, I'm not gonna spend that like valuable interview on you. And what I've done actually is look for people who might be ranked lower or screened based on some factors. For example, like an average USM only step two score. And then I'll delve into their application and look for things that tell me I would really like this person, think they'd be a great resident, maybe really great clinical greats or clinical comments or other features. So even if I'm currently sitting at number six on your list, and I have to assume that based on how you've signaled, you might just fall down farther on the rank list of places that even at the end of the season you prefer, but I think you're great. So I am being maybe a little bit overly strategic. But you know, I'm a I'm what they call a more of a mid to, I'll say I'm upper mid-tier program on the East Coast, maybe not as Stanford. But did you notice? You know, we talked about some of the changes on our end. You know, we read all these things about applicants, we look at their hobbies, or maybe we just hear through the grapevine what they're looking for. Did you see any shift in terms of the priorities that the applicants came to you with? That is a continuation of a shift or something new.

Marianne Chen, MD 11:53

I think what we often tell applicants that are applying to our program and probably very similarly to many, right? We we do a holistic review. And so we really want to see like the depth and breadth of an applicant, right? And so we we want to see that they're involved in a lot of different interests and passions and not necessarily just, you know, put all my effort into one thing. And so I I think as you're looking through these applications and you look you look through their you know activities and and the things they've been doing, it does really span things from a little bit more community engagement to research and and and so it spans a broader topic base, is what I've noticed over the past few years compared to when you would see an application and it was really just focused on their one major passion and and multiple activities based on that one thing.

Bryan Mahoney, MD 12:43

But did you did you have a sense of what they were looking for when they came to you? Like the kind of questions they were asking. Do you do you feel as though applicants are looking for something different from a career in anesthesia? I mean, we know we're so highly competitive now. Um, I think we're probably tapped into a different kind of applicant pool. Would you hear anything, maybe even behind the scenes, about what the applicants want?

Marianne Chen, MD 13:09

Oh, good question. Sorry, that was not what I interpreted your first question to be. So we at Stanford have lots of different pathway programs that are focused on interest within medicine, not specifically anesthesia, but like medicine globally. Um, we have a big innovations program. You know, I think people think Stanford, they think tech, health tech. So we do get a lot of applicants who were asked about those opportunities, right? Opportunities to network in Silicon Valley while while you're in training, opportunities to, you know, meet people within the school of biodesign and get involved in in startups and things like that. Um so we do, I do get a lot of questions focused on kind of, you know, the other opportunities that one may have during residency uh to explore. But I think that's maybe specific to to where we're located and and kind of the connections that we have at Stanford. We also get a lot of questions about global health because we have a big global health program. I think there's also, you know, a lot of interest within academics and learning more about medical education and how to be an educator as well as a great clinician during training. So I do think there is a lot of, at least for us in our program, questions about what's the other interest that I want to continue to pursue that I'm passionate about and what opportunities will happen.

Bryan Mahoney, MD 14:28

Marianne, yeah, we've been seeing still a lot of interest in global health. And for listeners, you know, we recently recorded a session speaking with uh heads of the ASA and SEA global health trips available to residents. So if you are listening to this and you're thinking, oh, we need global health opportunities for our residents, you don't have to make them in-house. There are opportunities available through our professional societies. We recently decided to sponsor a position with the SEA HVO Global Health Fellowship, which can help to enhance the chances of one of our residents getting uh one of those positions. It's an additional one because we're paying for it and it's really not that expensive. So PDs out there who are looking to expand global health opportunities, it's easier than you think. Marianne, have you sent any residents to the SEA or ASA global health trips recently?

Marianne Chen, MD 15:24

Yes, we've had one just recently accepted, and so we'll go next year, and we've had a resident who went this this past year as well. And so we encourage residents to apply through those opportunities, even if we have our own in-house opportunities.

Bryan Mahoney, MD 15:38

Well, that's some free advice for program directors, even new program directors, and we have a lot of new program directors out there. During the uh SAAPM, we have new PD sessions because there are so many. Based on what you've seen, let's say you were speaking to someone who's starting a new program, let's say down the street. What advice would you give to a new program director in light of your recent experience and the recent changes to the interviewing recruiting process?

Marianne Chen, MD 16:05

I had a a new ish PD recently asked me how we make our rank list and you know, how do we determine, you know, who goes in what position? And you know, I think a lot of us think about how we can, you know, make sure that we're matching the folks we want to come to our program and you know, ways that we can, you know, move people around the rank list to make that happen. But I, you know, gave her my advice of just rank how you normally would, just you know, based on the interviews, how you score, and the algorithm works. And, you know, I think that's shown every year as we all successfully match really wonderful candidates. I also told her that, you know, it was my third recruitment, my third match, and I still, you know, right before I submitted our rank list, like woke up to make sure that it was certified and did all those things that like haunt me of, you know, making sure everything is done correctly so that we can, you know, have a successful match. And that, you know, still happened to me this third year around. I'm sure for you, you know, as a veteran PD, you, you know, submit your list and don't think about it. But for some of us, you know, still still wake up, you know, sweating to make sure we did the right thing.

Bryan Mahoney, MD 17:13

No, not at all. I still have a panic attack that I did not certify my list appropriately. I might check it three or four times uh just to double check. So that never goes away.

Marianne Chen, MD 17:23

Good to know. I was like, when will this end? Will it ever end?

Bryan Mahoney, MD 17:29

How about your algorithm? Did you give them any advice about your approach in terms of the interview versus hard data?

Marianne Chen, MD 17:37

Yeah. So I think that every program needs to think about residents that will be successful at their program and what surrogates we have within the application to kind of help us make those decisions in addition to the interview. So everybody's gonna, I think, have a different, you know, review and and what they how they give priority to s to certain things versus others. And so I I you know, I think that's a very much an internal question. You have to talk to your program leadership, you have to talk to your chair and kind of come up with those priorities. We've tried in our program to look at like past match data, to think about how we used to look at files and and our score sheets and and come up with, you know, some way to determine what's worked and what's not. Unfortunately, that's that's challenging, right? I think that, you know, there's so many different parts of, you know, pieces of the puzzle that we look at. There's not one correct answer for any one program, but it's it's good to, you know, kind of look at your match, maybe iterate on what you've done to try to make things better. You know, at the end of the day, I think there are amazing students going to anesthesiology. So I think we're very fortunate that we're all gonna match really great candidates that are gonna be really successful. So that's also kind of just a nice feeling to have that, you know, like the application pull is super strong. And, you know, we're all gonna be able to work with these really great residents and and help our field.

Bryan Mahoney, MD 19:06

Well, I've thought about the same things, you know, we want to look back and see how we're doing in terms of our approach, but it's hard. You know, my my residents say, oh my God, you guys do such a great job. I love my classmates. And I say, you'd actually be shocked at what a bad job we do. Because if we think about the order in which people are ranked coming in and their success throughout residency, it seems a lot more stochastic and random than than one might think. We do something, we we select chiefs with a vote. So all of the residents and faculty get a vote. So the one outcome variable we do have, and I've thought about using this, is looking at the number of votes people get for chief, because it shows esteem across both faculty and residents. And again, here's AI again. Maybe AI can help us look through applications and application data and see if there's anything to take from it that can help us modify our internal algorithm. I think, you know, we're always looking to do better. And we always feel bad when someone doesn't do as well as you hope they would in residency. You guys seem like a great place to do that kind of thing using AI to assess the success of the match. Have you looked into that?

Marianne Chen, MD 20:17

Um, actually, perfect timing for this question. So I just met with some of my residency associate program directors yesterday, and we were talking about using AI to actually look at letters of recommendation, given that we think most people are using AI to generate those letters of recommendation. And so, kind of in the past few years, where there's probably more AI-generated letters, are there kind of key phrases, words that are being used that either help us or maybe hurt a candidate in in terms of how it's written or what is being said. And so definitely thinking of different ways that we can use AI to assess parts of the application and then looking at outcomes. Yeah. So we're excited about the possibilities. I think they're kind of endless. We just, you know, kind of need to sit down and do some work to see what happens with it.

Bryan Mahoney, MD 21:06

So we talked about the PDs. You're meeting with students all the time. I get so many requests for people to talk to them about, you know, applying for anesthesia. What kind of advice are you giving? Are you getting any new advice to candidates who are applying, say, next year based on the changes you've I mean, you've probably seen a lot of changes even over the three years you've been doing this.

Marianne Chen, MD 21:27

I think that we are fortunate at Stanford to have really great medical student clerkship directors that are involved in the recruitment process and have really great advice for the students. And so I think we're fortunate that the students that come speak with us are getting advice based on, you know, trends, updates to how signaling is working. We over the the past few years, I've I've definitely told students to get as much exposure to anesthesiology as they can. I think it's a field that's Changing in lots of different ways. And to understand that will better prepare them for, you know, what they might expect in residency and in their careers. I think, you know, for many of us, we would do a two or four week rotation and kind of applying anesthesia based on those experiences. But you know, there's you know, so many new special subspecialties and ways that people are practicing. So I always tell the students the more exposure they can get to the different types of practice, the better. So they have a clearer understanding of what they might be getting themselves into, as well as the way that medicine, you know, operated operations are changing is is ultimately going to affect what we do, right? Because we're we're so intertwined. And so that's usually the biggest advice I get that it's like they have, you know, you know, this is a career you're choosing. And we don't want people to go into the field if they're not necessarily understanding the complexity and breadth of what we do. And then to, you know, I'd hate for them to realize that halfway through residency and decide maybe this is not the field that's meant for them. But what advice do you give your students?

Bryan Mahoney, MD 23:01

Well, I guess I'm gonna ask you another question first. What is there anything that you that you think applicants or students don't know about our field with the limited exposure they get? You know, maybe you have residents who come to you later and say, wow, I didn't expect anesthesia, a career in anesthesia to be X, or I didn't expect to deal with issue X over the course of my training and in my future career as an anesthesiologist. What don't they know that you want them to know before they jump in head first?

Marianne Chen, MD 23:30

Probably lots of things. Um, I think that even as a resident, there was things that I didn't realize about anesthesia, and you know, as as things evolve, you know, even as a faculty member. Do you guys have your students take call on anesthesia?

Bryan Mahoney, MD 23:42

So that's great. And I so you're kind of pointing out one thing that's at the front of my mind. I actually sat down with someone today who was thinking about a transition to a career in anesthesia, which was a big decision for them. And I I said to them, you know, let's really talk brass tacks here because this is a major decision for you. Anesthesia is not a lifestyle profession. I think people perceive it to be. I always say the one thing no one realizes before they go into anesthesia is how many times they'll be sitting in an operating room in the evening, not thinking they would be there that late and not knowing when they're going home, because you know, we're tied to the operating rooms. Sometimes multiple surgeons have cases that take longer than they think. There were add-ons, there were emergencies. And if there's a room with surgery going on requiring anesthesia, there's an anesthesiologist in there. And I'm I almost wish, in addition to our physiology talks and our area workshops, we had a whole lesson on the unpredictability of the day-to-day life of an anesthesiologist. And for that reason, I think them taking a call would be great. We do not do that. In fact, our residents want to be nice and oftentimes send them home earlier than we want.

Marianne Chen, MD 24:47

Same thing with us. And I think that you're right. I think there's a lot of students who don't realize we have emergency operations on Saturdays. We have to have emergency operations at 3 a.m., right? You're an OB anesthesiologist. The L and D floor is always busy. There's never a time that it's not going to be busy. Christmas Day, it's going to be busy, right? New Year's Day. And so I think that having, you know, some call or some understanding of the evening work and the unpredictability of days is important because it will affect them during their entire career, unless they go into pain medicine. But for most of us, it'll affect us, you know, still. And it's part of what we do is that we are our schedules are not our own. Um our schedules are based on, you know, the surgeons we work with, the patients that need that need care at all times of the day. And so we do not have them take call, but have encouraged our medical standard crookship directors to think about that more and how we can incorporate that to have a more realistic understanding of, you know, how we practice 24 hours a day, seven days a week.

Bryan Mahoney, MD 25:54

We would just need to find a call room for them. But you know, you could probably make that change because I'm sure you have medical students beating down the door for an opportunity to do a rotation with you.

Marianne Chen, MD 26:04

Yes. I am not directly involved in our visiting student application process, but we have recently joined the VLSO program or process for visiting student applications and recently was chatting with our medical student clerkship directors, and we received a very large amount of applications for very few spots. I think it's also hard because most of the students want to rotate in the summer and fall, and that's when we're onboarding and orienting new residents, and it's hard to find them opportunities to, you know, be either one-on-one with the faculty or a senior resident, which is how we pair our students. And so I think that trend is definitely going up. What are you seeing in terms of the visiting medical student applications and how you're gonna approach that this year?

Bryan Mahoney, MD 26:52

Well, I mean, the demand is huge. You get multiple applications from a single applicant, so they might say, I'm willing to come for this number of months. So accounting for that, I believe this year we have almost 1,400 applications for rotation.

Marianne Chen, MD 27:09

That's a crazy number.

Bryan Mahoney, MD 27:10

It's a crazy number. And a few years ago, I decided to be much, much more involved in the selection process for a couple of reasons. One, it's the absolute best way to get to know people. I mean, if you work with someone for a month and you get to know them, nothing's ever a hundred percent, but the certainty that you're getting someone who's really going to be a great fit for your program increases dramatically with that experience with them. So it is a single best means for finding the best applicants for your program. And two, what I realized is they're so desperate to get these away rotations that they're applying very broadly. And in the past, I think that the administrative staff who helped us sort through them were not doing it as early in the season as I hoped. And I think a lot of great applicants were already committed to getting the first offers they got because you know, a bird in hand is worth more than two in the bush. So the second it opens, I've actually started reviewing and divvying up applications for a small cadre of um both residents. We actually have our education track residents now involved and faculty involved with our medical student rotation. I think that we sent out the vast majority of our invites within the first week after VSLO opened to try to get the people that we most wanted to come see us. And we also extended our away rotations. We used to end them before December, and now we have them coming up until rank lists are due, thinking that people who are really, really interested will make it happen to be here in January to be able to, you know, get a face-to-face opportunity to work with us and expanding our opportunity to meet great, great applicants. Is any of this consistent with uh what you guys are thinking about doing now that you've joined BSLO?

Marianne Chen, MD 28:56

Yeah, are definitely trying to soar through them earlier, getting invitations out a bit earlier. We're a little bit limited by how the Stanford School of Medicine works in terms of scheduling crook clerkship. So we actually don't even get access to the to some of the applications that are later in the fall, not until like next month. So it it does delay the process a bit just based on kind of the School of Medicine's timeline. How are you approaching the applications? Do you approach them like you would a residency application and you know who you're deciding should get an interview? Like, is there certain things you're asking for that may not be part of like the standard application process?

Bryan Mahoney, MD 29:35

In some instances, you know, we you do not get the same amount of information through the SLO that you get URAS. You're not getting board scores, they haven't taken it yet. You're not getting a dean's letter, it hasn't been completed yet. Some will, they'll all upload their transcripts, some of which don't even have grades or rankings because that doesn't get decided on until later. So basically, we get a resume. We have been telling the non-allopathic students that we do need to see their transcript. Uh, we will every year consider a very, very small number of non-allopathic students, and I want to make sure that they're not wasting their time. So I want to see a transcript that just shows they're going to be a lights out candidate and be, you know, considered to be ranked uh appropriately if they do a great job. Other than that, I'm just looking through resumes and I'll actually give you a little anecdote. I was perusing resumes last year, and I was in the OR, there was an intern that I was training, and we have some major downtime. So I'm just perusing. I think she overheard me say, you know, oh, this person majored in history. That's cool. I want to meet them. And they said to think that something so random can alter like the trajectory of a person's entire life. But when all you have is a resume, I'm just looking for people who I think are interesting, fun, are bring gonna bring something different. And actually that influences when I talk to people in undergrad who are applying to medicine, they all think they have to study biochemistry. I said, Oh, for the love of God, study philosophy, you know, study religion, do something interesting. You need to know how many biology majors we see here. We don't need more. So it's it's actually just hobbies, what they studied, you know, some of the things they were involved in, play almost a bigger role, I think, in selection because you don't have other screening mechanisms. How about you guys?

Marianne Chen, MD 31:23

Do you offer all of your visiting students a interview?

Bryan Mahoney, MD 31:27

I do, but that's a little bit complicated. So I have been convinced, I've been one over that all students, regardless of whether or not they do an away rotation or are a home student, should be signaling appropriately, regardless. I.e. if you do a rotation with me, you should still use a gold signal if I'm in your top five. The reason I've been one over to that argument is that it really messes up the data that students are getting. And if they are trying to gamify the data, then they're getting bad information to make their decisions. So my dirt, my my dirty secret on a podcast everyone can hear is that I would never not interview someone that did a rotation. I just don't, I don't think the fallout from that is is worth it. But I am going to tell them that they need to signal me in terms of how much they're favoring our program. So use the signal the same as you would for any other program. How about you guys?

Marianne Chen, MD 32:21

Yeah, so I'm probably guilty of presenting bad data and not helpful data. So we will now tell all of our students and visiting students, all of our internal Stanford students and visiting students to signal as they would if we're in their top five, in their top 15, because we were uh previously not. Uh so we will switch that this upcoming year, make sure the data is accurate. And in terms of how we look at applications, um, our my two medical student clerkship directors are also in our recruitment committee. So they, you know, are hearing about you know the things that are talked about, what we look for in the applications, and so try to mimic that a bit with the information they're getting. But like you said, it's it's it's very limited compared to what we get through ARIS. And so making kind of, you know, decisions based on like little connections, things that that stand out in an application. But it's it's challenging just because I think there are so many applications to go through. And, you know, after a while, it uh you don't want to kind of play into your biases and you, you know, want to make sure that you're you're treating each application fairly. So I'm glad that I don't personally participate in that. Um, but I do trust my clerkship directors. Um, and we've had some really wonderful visiting students who have matched with us. So know that the process is is working and and uh hopefully will continue to grow and develop.

Bryan Mahoney, MD 33:38

So would you encourage students to pursue away rotations more than maybe they've been told to in the past?

Marianne Chen, MD 33:45

I have mixed feelings about that. I really think the visiting rotation is for the benefit of the student, right? Especially as we're doing virtual interviews, a student can have the opportunity to meet the residents and faculty, kind of experience the culture of a place, experience the workflow, see if this importantly is a place they want to live for three to four years, right? Especially if they're they've never lived in the area before or coming from across the country or a different part of the country. So it's really an opportunity for them to just really immerse themselves in what their life may be like for the next four years. And so really see it as as for the student and not necessarily for the program. And they can make you know more educated decisions as as they make their rink list and and after they've interviewed. Again, I I think that it's not an opportunity that everybody can do. So there is inevitably some inequity to the process, which I don't love. And so I don't want to put too much on the visiting rotation just because not everybody can do it.

Bryan Mahoney, MD 34:51

Mount Sine actually offers a scholarship, a needs-based scholarship to students who are interested in doing a rotation within the Mount Sinai healthcare system. And it's a cost that's borne half by the medical school and half by the receiving departments. So for those of you out there, if any if any students are applicants or even people mentoring them or listening, there are programs that do offer some financial assistance for away rotation is to try to even the playing field. That might be actually a good topic for a future discussion. Um, but it's been another thrilling year. Any any other topics you think we should touch upon before we sign off on this episode?

Marianne Chen, MD 35:29

No, I think that, you know, I think we were excited to kind of get through another recruitment cycle, excited to, you know, see some really wonderful match results. And excited to start this all over again soon. There doesn't seem to really be a break ever in recruitment. And, you know, you started talking about how your chiefs were, you know, amazed by that. I think my chiefs similarly said like recruitment really never ends. There's like never really a break and and stopping to to think about something else. And I'm like, yep, think about it all the time, all year round.

Bryan Mahoney, MD 36:01

Actually, I'll sign off with my last bit of advice for new program directors. All the work you put in on this end, it's all worth it. The extra time on recruitment saves you so much headache and heartache on the other side of things. So if you think some people are crazy with the amount of energy they put into recruitment, they're spending a lot less energy on dealing with problems because they didn't put enough time into recruitment. That might be the best advice I could give somebody.

Marianne Chen, MD 36:28

So true. Love that. Well, thanks again, Brian. Always good chatting. And uh thank you, everyone, for listening. We look forward to chatting again with you all soon.

Larry Chu, MD (Producer) 36:35

Thank you. Thank you for joining us on PDS at SEA. If you found this conversation valuable, we invite you to subscribe and share the podcast with colleagues who are committed to advancing anesthesiology education. You can access additional episodes and resources from the Society for Education in Anesthesia at seahq.org. We welcome your questions and suggestions for future episodes. Please contact us at PDSATSEA at seahq.org. This podcast is produced by the Stanford AIM Lab on behalf of the Society for Education in Anesthesia. Thank you for your dedication to teaching the next generation of anesthesiologists. We'll see you next time on PDS at SEA.