Résumés
Abstract
The authors describe the residency match as a two-step process. The first step, the Choice, is where students use a combination of intuitive and analytic information processing to select the specialty that they believe will provide fulfilment and work-life balance over their entire career. The second step, the Match, uses a “deferred-acceptance” algorithm to optimize pairing of students and their specialty choices. Despite being the rate-limiting step, in the minds of students and other stakeholders, the outcomes of the Choice have typically been eclipsed by the outcomes of the Match. A recently published study found that during their second year of residency training, one in 14 physicians reported specialty choice regret, which associates with symptoms of burnout in residents. While the obvious solution is to design interventions that improve the specialty choices of students, this approach faces significant challenges, including the fact that: 1) satisfaction with specialty choice is a difficult-to-define construct; 2) specialty choice regret may be misattributed to a poor choice; and 3) choosing is a more complicated process than matching. The authors end by suggesting that if we hope to improve satisfaction with specialty choice then we should begin by defining this, deciding when to assess it, and then creating assessment tools for which there is validity evidence and that can identify the underlying causes of specialty choice regret.
Résumé
Les auteurs décrivent le jumelage des résidents comme un processus en deux étapes. La première étape, le Choix, est celle où les étudiants utilisent une combinaison de traitement intuitif et analytique de l'information pour sélectionner la spécialité qui, selon eux, leur apportera l'épanouissement et l'équilibre entre leur vie professionnelle et leur vie privée tout au long de leur carrière. La deuxième étape, le Match, utilise un algorithme « d'acceptation différée » pour optimiser le jumelage des étudiants et de leurs choix de spécialité. Bien qu’ils soient l’étape limitante du processus, selon les étudiants et d’autres parties prenantes, les résultats du Choix sont généralement éclipsés par ceux du jumelage. Une étude récemment publiée a révélé que, durant leur deuxième année de résidence, un médecin sur quatorze regrette d'avoir choisi une spécialité, ce qui est associé à des symptômes d'épuisement professionnel chez les résidents. Bien que la solution évidente soit de développer des interventions qui améliorent les choix de spécialité des étudiants, cette approche pose des défis importants, notamment le fait que : 1) la satisfaction à l'égard du choix de la spécialité est un concept difficile à définir ; 2) le regret du choix de la spécialité peut être attribué à tort à un mauvais choix ; et 3) le choix est un processus plus complexe que le jumelage. Les auteurs concluent en suggérant que si nous espérons améliorer la satisfaction à l'égard du choix de la spécialité, nous devrions commencer par définir ce concept, décider quand l'évaluer, puis créer des outils d'évaluation pour lesquels il existe des preuves de validité et qui peuvent identifier les causes sous-jacentes des regrets à l'égard du choix de la spécialité.
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