The research team, led by Carl Berghult, Joseph Mellberg, Lachlan Anderson, Erica Olfson, and David Shau of the Anne Marion Burnett School of Medicine at Texas Christian University and the Texas Hip and Knee Foundation in Fort Worth, undertook an ambitious cross-sectional analysis of the entire population of orthopaedic surgery residents in ACGME-accredited programs. Rather than sampling, they assembled a census: 3,844 residents across 215 orthopaedic residency programs. The investigators built their dataset from publicly accessible sources, including program rosters, institutional directories, social media profiles, and medical school websites, a method that allowed them to map the educational origins of virtually every orthopaedic resident in the United States without touching any private or identifiable information.

The analytical design is what gives the study its distinctive angle. Because the researchers could not determine the exact date each resident sat for Step 1, they used postgraduate year, or PGY level, as a temporal proxy for the scoring era. Residents in their first through third years of training, PGY-1 through PGY-3, would have entered the Match during or after the transition period surrounding the pass/fail switch, while PGY-4 and PGY-5 residents represented cohorts that matched under the old numeric scoring regime. This stratification allowed the team to compare whether the relationship between medical school characteristics and residency program rank differed between Match eras, effectively using the resident population itself as a natural archive of the transition.

The central finding is striking. Among PGY-1 through PGY-3 residents, the more recent Match-era cohorts, medical school rank correlated significantly with the rank of the residency program the graduate ultimately joined. Among PGY-4 and PGY-5 residents, who matched under numeric Step 1 scoring, no such significant association was observed. In other words, before the scoring change, a graduate’s medical school pedigree showed no measurable statistical relationship with the standing of their orthopaedic program; after the transition, that relationship emerged. The authors are careful to frame this as a temporal association observed in an observational, cross-sectional study, not proof of causation, but the pattern is consistent with the hypothesis that when a familiar screening metric disappears, selection processes shift toward other signals, including institutional prestige.

The magnitude of some institutional effects deserves attention. Graduates of Tier 1 medical schools, as ranked by U.S. News & World Report, had the highest median residency program rank in the dataset, at 47. Even more dramatic was the divide between allopathic and osteopathic graduates: MD students had approximately ten-fold higher odds of training in a higher-ranked orthopaedic residency program compared with DO students. The study also examined what the authors call orphan status, meaning medical schools with no affiliated orthopaedic residency program of their own. Graduates of such schools faced roughly 40 percent lower odds of matching into a higher-ranked program. These are not trivial differences; they suggest that structural features of a medical school, some of them dating back to decisions made long before an applicant ever matriculated, are woven into match outcomes.

Methodologically, the team treated residency program rank as an ordinal outcome and deployed a battery of statistical tools appropriate to that structure. Chi-square tests assessed categorical associations, while univariate and multivariate ordinal logistic regression quantified the odds of landing in a higher-ranked program across school characteristics, controlling for other variables. Spearman correlation coefficients measured the rank-order relationship between medical school rank and residency program rank. Ordinal logistic regression is particularly well suited to this kind of question because residency program quality is inherently a ranked, non-continuous quantity, and the approach allows researchers to model the probability of falling into a higher rather than a lower category without assuming equal spacing between ranks.

The categorization scheme the researchers used reveals how many dimensions of medical school identity they considered. Beyond the U.S. News & World Report rankings and the Tier 1 designation, schools were classified as allopathic versus osteopathic, public versus private, and orphan versus non-orphan status. Each of these categories captures a different facet of institutional infrastructure. Allopathic versus osteopathic status reflects two parallel systems of medical education in the United States with different historical pathways to licensure. Public versus private status often correlates with funding structures and state-based admissions pipelines. Orphan status speaks to the presence or absence of an in-house orthopaedic residency, which can shape access to mentorship, research opportunities, letters of recommendation from orthopaedic faculty, and early exposure to the specialty, all factors long suspected to influence match success.

Why would the pass/fail transition amplify the role of institutional characteristics? The logic articulated in the study is straightforward. Before 2022, Step 1 scores served as a standardized, nationwide screening tool that programs could apply uniformly to every applicant, regardless of origin. With the numeric signal gone, programs lost their most convenient common denominator and may have turned to alternative applicant characteristics to fill the gap. Where a candidate went to school, whether that school hosts its own orthopaedic department, and the degree-granting tradition behind the diploma are all visible on an application in ways that raw ability is not. If programs lean more heavily on such proxies, the statistical imprint of institutional background on match outcomes would be expected to deepen, exactly the pattern the PGY-stratified analysis detected.

The authors are explicit about the limitations that bound their conclusions. The use of PGY level as a proxy for Step 1 scoring era is an approximation, not a direct measurement, since individual examination dates were unavailable and some residents delay graduation or take the examination at different points in their training. The cross-sectional design captures a single snapshot of the resident population rather than following individuals over time, and observational data of this kind cannot establish that the scoring change caused the observed associations. Residency program rank itself, derived from reputation-based rankings, is an imperfect measure of training quality. The study also relied on publicly available information, which, while ethically clean and free of privacy concerns, may contain occasional inaccuracies in self-reported credentials or affiliations.

Nevertheless, the implications ripple outward across medical education. For applicants, the findings suggest that in the pass/fail era, the road to a top orthopaedic residency may run more visibly through institutional channels, making mentorship, research access, and home-program support more decisive than ever. For osteopathic medical students and graduates of schools without affiliated orthopaedic residencies, the ten-fold and 40 percent odds differences quantify a structural headwind that predates any individual performance. For residency programs and policy makers, the results raise a pointed question about equity: if removing a standardized numeric metric shifts selection toward characteristics that track institutional privilege, the profession may need to develop new, fairer ways to evaluate the growing pool of pass/fail-era applicants. With no external funding and no declared competing interests, the study offers an open-access, data-driven starting point for that conversation as the first fully pass/fail-era Match cohorts continue to move through training.

Subject of Research: The association between medical school characteristics and orthopaedic residency match outcomes before and after the USMLE Step 1 pass/fail transition

Article Title: Medical school ranking and orthopaedic match outcomes in the USMLE Step 1 pass/fail era: a PGY-stratified analysis

Article References: Berghult, C., Mellberg, J., Anderson, L., Olfson, E., & Shau, D. (2026). Medical school ranking and orthopaedic match outcomes in the USMLE Step 1 pass/fail era: a PGY-stratified analysis. BMC Medical Education. https://doi.org/10.1186/s12909-026-10594-z

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10594-z

Keywords: orthopaedic surgery residency, USMLE Step 1, pass/fail scoring, medical school ranking, residency match, medical education, applicant selection, MD versus DO, ordinal logistic regression, ACGME, PGY-stratified analysis, health equity

Dermatology occupies a peculiar position in the landscape of medical specialties. It is consistently among the most competitive fields in the National Resident Matching Program’s annual Main Residency Match, attracting applicants with exceptional academic records, and it is simultaneously a specialty in which scholarly output is widely treated as a proxy for rigor, curiosity, and future potential. Program directors reviewing applications frequently encounter candidates with peer-reviewed publications, conference abstracts, and case reports completed before they have even graduated from medical school. Whether that early productivity actually predicts who will eventually build a career in academic dermatology, however, is a question that has generated a small but growing body of literature, and the new analysis is designed to speak directly to it.

The methodological logic of a retrospective analysis of this kind is straightforward even when the execution is demanding. Researchers identify a cohort of individuals who have completed dermatology training, reconstruct their records of scholarly activity from publicly available databases and institutional sources, and then examine whether measures of productivity, such as publication counts, authorship positions, and the timing of early papers, are associated with subsequent career outcomes, particularly the pursuit of academic rather than private-practice positions. Because the data are collected after the fact rather than prospectively, the approach cannot establish causation, but it can reveal patterns and associations that are difficult to observe in cross-sectional snapshots of applicants or trainees.

That caveat matters, and the authors of the new research letter are careful to frame their work within an existing evidence base rather than as a definitive verdict. Prior studies have examined pieces of this puzzle from different angles. A 2018 analysis published in JAMA Dermatology by Shi, Tung, and Nambudiri investigated demographic, academic, and publication factors associated with the selection of an academic dermatology career, finding that publication history was among the characteristics that distinguished those who chose academic paths. A 2022 cross-sectional analysis in the Journal of the American Academy of Dermatology, which included several of the same investigators as the new study, documented the scholarly work and mentor relationships of matched dermatology residency applicants, highlighting how deeply embedded research experience has become in the application process itself.

Further upstream, a 2023 cross-sectional study in the Archives of Dermatological Research by Gupta, Tamashunas, Ramanathan, and colleagues, including senior author John F. Scott, examined research productivity during medical school and dermatology residency, mapping how scholarly output accumulates across the training timeline. And in 2020, Stephens, Barbieri, and Lipoff published an analysis in the Journal of the American Academy of Dermatology asking whether publications produced during medical school could predict future academic productivity in dermatology, an early attempt to test the predictive validity of the metrics that selection committees implicitly rely upon. Taken together, these studies sketch a field in which early research activity is common, measurable, and increasingly scrutinized as a signal of future scholarly commitment.

The new research letter extends this line of inquiry by connecting productivity measures to career destinations, asking in effect whether the publication record that helps a candidate match into dermatology also foreshadows whether that dermatologist will ultimately join a university department. The question is consequential for more than individual applicants. Academic dermatology departments depend on a steady influx of physician-scientists and clinician-investigators to advance the understanding of skin disease, from common inflammatory conditions such as psoriasis and atopic dermatitis to melanoma and other skin cancers. If the pipeline from residency to faculty appointments is narrowing, or if the predictors of academic entry are changing, departments need that information to design mentoring programs, protected research time, and early career support that actually work.

The study also speaks to a broader anxiety in academic medicine about the so-called publication arms race. As competitive specialties have attracted applicants with ever longer lists of publications, critics have worried that the system rewards volume over substance, encourages salami-sliced research, and disadvantages students from schools without robust research infrastructure or well-connected mentors. A retrospective analysis that tracks productivity into actual careers can help clarify whether early output is a genuine signal of durable scholarly interest or merely a credentialing exercise that loses predictive power once the match is over. The distinction has practical implications: if early publications do predict academic careers, then expanding research opportunities for underrepresented applicants could meaningfully diversify the faculty pipeline; if they do not, selection committees may need to look for other indicators of long-term scholarly potential.

The authorship of the new study reflects the collaborative, multi-institutional character of contemporary dermatology research. In addition to first author Maggie H. Zhou of Columbia, the team includes Wei Li, Anisah Alladeen, and Alexis Mitelman of Weill Cornell Medical College, Amar D. Desai of the Department of Dermatology at Northwestern University in Chicago, and corresponding author Shari R. Lipner of the Department of Dermatology at Weill Cornell Medicine in New York. According to the contributor statement, all authors contributed to the conception and design of the study, data collection and analysis were performed by Zhou, Li, Alladeen, and Mitelman, the first draft was written by Zhou, and all authors reviewed the manuscript. The authors report no conflicts of interest apart from Lipner’s disclosed consulting relationships with Moberg Pharmaceuticals and BelleTorus Corporation, and the study received no dedicated funding.

Published as a research letter rather than a full-length original article, the study follows the compact format that many dermatology and general medical journals reserve for focused analyses with a single clear question. Research letters typically present a concise cohort description, a limited set of outcome measures, and a short interpretation, trading comprehensiveness for speed and clarity. The format suits questions about career trajectories, which often hinge on a handful of well-defined variables, but it also means that readers should expect the nuances, subgroup analyses, and sensitivity checks of a larger investigation to be limited. The authors note that all data supporting the findings are available within the paper and its supplementary information, which accompanies the article as an online document.

For students and residents weighing their own futures, the accumulating evidence offers a consistent if sobering message: research productivity during training is closely watched, appears to correlate with academic career selection in prior analyses, and is likely to remain a central currency of competitive dermatology for the foreseeable future. For program directors and department chairs, the message is more structural. If the specialty wants to sustain its academic workforce, it cannot simply rely on the self-selection of the most productive trainees; it must understand which forms of early mentorship and scholarly engagement translate into lasting academic commitment. The new retrospective analysis, situated within a decade of related work by Shi and colleagues, Gupta and colleagues, Yeh and colleagues, and Stephens and colleagues, gives the field one more empirical anchor for those decisions, and it underscores a conclusion that is emerging across academic medicine: the path to a faculty career begins far earlier than the first faculty appointment, and the choices made in medical school and residency echo through an entire professional lifetime.

Subject of Research: The relationship between research productivity during medical training and the pursuit of academic medicine careers in dermatology

Article Title: Retrospective analysis of research productivity and academic medicine careers in dermatology

Article References: Zhou, M. H., Li, W., Alladeen, A., Mitelman, A., Desai, A. D., & Lipner, S. R. (2026). Retrospective analysis of research productivity and academic medicine careers in dermatology. Archives of Dermatological Research, 318(1), Article 407. https://doi.org/10.1007/s00403-026-04906-y

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04906-y

Keywords: dermatology, academic medicine, research productivity, medical education, residency match, publication record, physician-scientists, career outcomes, retrospective study, mentorship, Archives of Dermatological Research, faculty pipeline

Dermatology has long occupied a peculiar position in American graduate medical education. It is consistently among the most competitive specialties in the National Resident Matching Program, the algorithm-driven process that pairs applicants with training positions. The combination of a limited number of residency slots, desirable lifestyle characteristics, and strong career prospects means that the ratio of applicants to positions is among the highest in medicine. For students, that competition translates into anxiety, and anxiety, in turn, translates into strategy. One of the most visible strategies is the dual application: submitting materials not only to dermatology programs but also to a second specialty, typically one perceived as less competitive, as a hedge against the possibility of not matching.

The technical foundation of the new analysis is the ERAS specialty dashboard, a publicly accessible data product maintained by the Association of American Medical Colleges. The dashboard aggregates application statistics by specialty and by cycle, allowing researchers to track how many applicants to a given specialty also designated applications to other specialties in the same cycle. By pulling these figures for each application year from 2022 through 2026, the research team was able to construct a five-year cross-sectional picture of dual-application behavior among dermatology applicants. Because the data are publicly available, the study required no institutional review board approval, and the authors have made supplemental methods and data available through a public repository to allow independent verification of their analysis.

The appeal of such an approach is its transparency. Rather than relying on surveys, which are vulnerable to recall bias and to the reluctance of applicants to admit hedging behavior, the ERAS dashboard captures what applicants actually did when they submitted their applications. That distinction matters, because dual applications are a sensitive topic. Advisors and program directors have debated for years whether applying to two specialties signals genuine interest in both fields or a lack of commitment to either, and whether such applications dilute the applicant pool or simply reflect rational behavior under uncertainty. Administrative data sidestep those confessions and report the behavior directly.

The context in which this research appears is one of mounting pressure on the residency pipeline. The Association of American Medical Colleges has repeatedly projected a continuing shortage of physicians in the United States, a forecast that has intensified scrutiny of how medical students choose specialties and how residency programs select trainees. At the same time, the total number of applications submitted per applicant has risen across many specialties, a phenomenon that has been criticized for inflating competition and straining program review capacity. Against that backdrop, dual applications occupy an ambiguous position: from the applicant’s perspective they are a risk-management tool, but from the perspective of specialties and programs they complicate the interpretation of application numbers and may distort the apparent competitiveness of a field.

The ethical dimension of the trend has not gone unnoticed. A companion commentary by several overlapping authors, published in the Journal of the American Academy of Dermatology, explores the implications of dual-specialty applications for medical student advisors, raising questions about the duty advisors owe to students who are torn between fields, and about the fairness of a system in which well-advised students can hedge while others cannot. The research letter and the commentary together frame dual applications not merely as a statistical curiosity but as a structural feature of the match ecosystem that deserves deliberate policy attention rather than informal folklore.

For dermatology specifically, the stakes are concrete. Program directors rely on application data to gauge interest, to set screening thresholds, and to decide how to allocate interview invitations. If a meaningful fraction of dermatology applicants are simultaneously pursuing another specialty, the raw applicant count may overstate the number of candidates who would actually accept a dermatology position, while the number of applications per applicant may inflate the workload of reviewing programs. Conversely, applicants who dual apply face their own dilemmas: how to present a credible narrative of commitment to two different fields, how to schedule audition rotations and letters of recommendation across specialties, and how to answer the inevitable interview question about which specialty they truly prefer.

The study’s timeframe is itself significant. The 2022 to 2026 window spans a period of unusual turbulence in graduate medical education, encompassing the aftermath of the pandemic-era shift to virtual interviews, ongoing debates about the role of United States Medical Licensing Examination scores in screening, and growing adoption of holistic review practices that de-emphasize quantitative metrics in favor of broader assessment of candidates. Each of these shifts alters the calculus that applicants use when deciding whether to hedge. A student who might once have relied on a strong Step score to secure dermatology interviews may now face more uncertainty about how they will be evaluated, and uncertainty is precisely the condition that drives dual applications.

The researchers also situate their work within a broader effort to demystify the dermatology application process. A recent multi-part series in Clinics in Dermatology has examined the path forward for the specialty, including holistic review, equity and inclusion, and post-match solutions, reflecting a specialty-wide recognition that the current system produces stress for applicants and inefficiency for programs. The new ERAS dashboard analysis contributes an empirical baseline to that conversation: before stakeholders can evaluate whether dual applications are rising, stabilizing, or falling, and before they can design interventions, they need reliable descriptive data on the scale of the phenomenon. That is precisely what a cross-sectional analysis of five consecutive application cycles provides.

What emerges from the study is a portrait of a specialty at an inflection point. Dermatology remains a destination field, but the behavior of its applicants reveals the strategic adaptations that extreme competition produces. Dual-specialty applications are the visible signature of that adaptation, and the ERAS specialty dashboard offers a way to monitor it year by year without burdening applicants with additional surveys. The authors, who report no funding and no competing interests, frame their work as a descriptive contribution intended to inform advisors, program directors, and national organizations as they weigh reforms to the application process. Whether the appropriate response is better advising, changes to how programs screen applications, or structural reforms to the match itself remains an open question, but the study makes clear that the question can no longer be answered anecdotally. With public data now covering half a decade of applicant behavior, the conversation about dual applications in dermatology can move from speculation to evidence, and the specialty can begin to decide whether hedging is a problem to be solved or simply a rational response to a system that applicants did not design.

Subject of Research: Dual-specialty residency application trends among dermatology applicants in the ERAS system

Article Title: Trends in dual-specialty applications among dermatology applicants: a cross-sectional analysis from 2022 to 2026 of the ERAS specialty dashboard

Article References: Fleshner, L., Moon, J., Klufas, T., Zhou, A. E., Grant-Kels, J. M., & Klufas, D. M. (2026). Trends in dual-specialty applications among dermatology applicants: a cross-sectional analysis from 2022 to 2026 of the ERAS specialty dashboard. Archives of Dermatological Research, 318(1), Article 523. https://doi.org/10.1007/s00403-026-04996-8

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04996-8

Keywords: dermatology, residency match, ERAS, dual-specialty applications, medical education, NRMP, AAMC, application trends, physician workforce, holistic review, international medical graduates, USMLE

The study enrolled first- and second-year medical students who completed the externship during scheduled academic breaks, a design choice that allowed participants to engage fully without competing with required coursework. Across six separate cohorts, 36 students took part in the program, and 34 of them, or 94.4 percent, completed both the pre-program and post-program surveys, giving the researchers an unusually complete dataset for an educational intervention of this kind. The participants had a mean age of 24.4 years, and 58.8 percent identified as female, a demographic profile broadly representative of contemporary medical school classes in the United States. Because the study was prospective, with surveys administered before and after the externship, the investigators could track changes within each individual rather than relying on retrospective recall.

The structure of the externship itself is central to understanding its impact. Rather than offering passive observation, the program rotated students through the operating room, the outpatient clinic, and morning rounds, pairing each setting with resident-led surgical workshops that emphasized practical skills. This combination meant that students saw the full arc of otolaryngology practice: the preoperative evaluation in clinic, the technical demands of surgery, and the postoperative management that follows. The resident-led workshops deserve particular attention, because they positioned near-peers rather than senior faculty as instructors, a format that educational research has repeatedly linked to reduced anxiety and more honest questions from junior learners. For students who had never scrubbed into a case, the opportunity to handle instruments and rehearse techniques under resident supervision represented a first encounter with surgical culture that lectures cannot replicate.

To measure the program’s effects, the researchers used a 15-item survey scored on a five-point Likert scale, in which respondents rated their agreement with statements ranging from 1 for strongly disagree to 5 for strongly agree. The survey items targeted three domains: career interest in otolaryngology, self-assessed knowledge of the field, and confidence in both clinical and surgical settings. Because the same students completed the survey twice, the investigators analyzed the paired responses using Wilcoxon matched-pairs signed-rank tests, a nonparametric statistical method appropriate for ordinal data that does not assume a normal distribution. This choice of analysis is technically important, since Likert-scale responses are inherently ordered rather than continuous, and parametric tests such as the paired t-test can produce misleading results when applied to such data.

The results were striking in both their magnitude and their statistical consistency. Post-program scores were significantly higher than pre-program scores for understanding of otolaryngology as a career, for knowledge of head and neck anatomy, and for confidence in the operating room, with each comparison reaching a p value below 0.0001. In practical terms, a p value that small means the probability of observing such large improvements by chance alone is vanishingly remote, even after accounting for multiple comparisons. The median total survey score rose from 31 before the intervention, with an interquartile range of 24.5 to 35.5, to 44 afterward, with an interquartile range of 40.0 to 45.0, again with a p value below 0.0001. An increase of thirteen points on a scale whose theoretical maximum is 75 represents a shift from the middle of the response range toward its upper end, and the tightening of the interquartile range suggests that the improvement was consistent across participants rather than driven by a few enthusiastic outliers.

The career-interest findings may prove the most consequential for the specialty itself. After completing the externship, 82.4 percent of participants reported increased interest in otolaryngology, and 94.1 percent indicated greater interest in pursuing the field as a career. Otolaryngology is among the most competitive specialties in the National Resident Matching Program, and applicants who discover the field late in their training often struggle to accumulate the research experience, letters of recommendation, and clinical exposure that successful applications require. By introducing students to the specialty in their first or second year, the externship gives them time to build a coherent application narrative, seek mentorship, and confirm that the field genuinely suits them before the match process begins. Early exposure, in other words, functions not only as education but as a pipeline intervention.

The study’s authors describe the program as student-driven, and that characterization carries real weight for institutions considering similar initiatives. The externship was extracurricular, meaning it did not require curricular reform, new course slots, or approval from a medical school committee to operate. Its resource demands were correspondingly low: the essential ingredients were willing residents and faculty, access to operating rooms and clinics that already function daily, and a coordinator to manage logistics. The researchers explicitly note that this structure and its low-resource profile support replicability across institutions, positioning the Jefferson model as a template that other departments could adapt without significant financial investment. Among formally evaluated programs of this kind, the authors report that theirs is one of the first, which makes the prospective data especially valuable as a benchmark for future efforts.

The study did receive ethics approval from the Thomas Jefferson University Institutional Review Board and was conducted in accordance with the Declaration of Helsinki, and the work was presented at the Combined Otolaryngology Spring Meeting in New Orleans in May 2025 before its publication on 13 October 2026. The authors declare no competing interests and received no external funding, details that strengthen the credibility of the findings. Nevertheless, some limitations are worth keeping in view when interpreting the results. The self-reported outcome measures capture perceived knowledge and confidence rather than objectively tested competence, and students who volunteer for an otolaryngology externship are plausibly more predisposed toward the specialty than their peers, a selection effect that no pre-post design can fully eliminate. The single-institution setting, while enabling careful program control, leaves open the question of whether identical results would emerge at schools with different resources or patient populations.

Even with those caveats, the findings arrive at a moment when medical educators are actively searching for scalable ways to counteract what many describe as specialty blindness among preclinical students. The conventional assumption has been that meaningful specialty exposure requires months of clinical time that preclinical curricula cannot spare, but this study suggests that intensity and structure may matter more than duration. A single week, deliberately organized around the operating room, the clinic, rounds, and skills workshops, produced measurable and statistically robust changes in how students understood and valued a surgical specialty. If replicated at other institutions, the model could reshape how medical schools approach early career development, shifting the burden from curricular overhauls to lean, department-level partnerships between residents and eager first- and second-year students. For a specialty competing for talent against fields with far earlier curricular visibility, that is a message worth hearing.

Subject of Research: A prospective evaluation of a structured preclinical otolaryngology externship on medical students' knowledge, confidence, and career interest

Article Title: The early exposure advantage: a prospective evaluation of a structured preclinical otolaryngology externship

Article References: Sina, E. M., Estephan, L. E., Corr, A., Wride, W., Moroco, A., Huntley, C., Goldman, R., & Cognetti, D. (2026). The early exposure advantage: a prospective evaluation of a structured preclinical otolaryngology externship. BMC Medical Education. https://doi.org/10.1186/s12909-026-10579-y

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10579-y

Keywords: otolaryngology, medical education, preclinical students, externship, career development, surgical education, curriculum development, prospective cohort study, Wilcoxon signed-rank test, residency match, experiential learning, Thomas Jefferson University

The research, led by J. Christopher Polanco-Santana of Beth Israel Deaconess Medical Center and Harvard Medical School, together with Alessandra Storino of UT Southwestern Medical Center, Daniel Wong, and senior author Tara S. Kent, builds on the team’s earlier work. In a previous study published in the Journal of Surgical Education, the same group demonstrated that ethnic and racial bias existed in the MSPEs of general surgery residency applicants when measured by the differential use of two categories of descriptive language: agentic and communal terms. Agentic words, such as assertive, confident, independent, and ambitious, describe traits associated with leadership, self-direction, and achievement. Communal words, such as caring, compassionate, helpful, and warm, describe traits associated with relationships and interpersonal connection. Decades of research in social psychology and organizational behavior have shown that agentic language tends to be associated with professional success, particularly in competitive and high-status fields like surgery, while communal language, though positive, is less often linked to perceptions of leadership and excellence.

What remained unknown after that earlier study was which portion of the MSPE was responsible for the biased word use. The MSPE is not a monolithic document. It contains multiple distinct sections, including a summary or evaluation section, often referred to as the structural portion, in which the writer distills the applicant’s overall performance into a synthesis and often a comparative statement about where the student stands relative to peers. Other portions include the academic history, professional performance evaluations organized by clerkship, and the applicant’s own noteworthy characteristics. Each section is written under different circumstances and may draw on different sources of information, which means that bias could, in principle, be concentrated anywhere in the document. Identifying the specific source matters enormously, because targeted interventions, whether in writer training, template design, or automated language screening, can only be effective if they are aimed at the right section.

To answer the question, the researchers conducted a retrospective study of all MSPEs submitted by applicants to categorical general surgery residency positions at a single academic institution across two consecutive Match cycles. The final dataset comprised 1,314 evaluations drawn from 146 different medical schools, giving the analysis a broad national sampling of how these documents are written across the United States. The two application cycles were comparable at baseline, and the gender distribution of the applicant pool was nearly even, with women making up 51.6 percent of applicants. Most applicants identified as white, accounting for 52.7 percent, or Asian, accounting for 25.3 percent, while 17 percent of applicants self-identified as underrepresented in medicine, a designation that includes racial and ethnic groups whose representation in the medical profession is disproportionately low relative to their share of the general population.

The methodological core of the study was the calculation of a bias score for each distinct portion of the MSPE. Rather than treating the document as a single block of text, the researchers computed separate scores reflecting the relative frequency of agentic versus communal terms in each section. They then used multivariable regression, a statistical technique that allows researchers to assess the association between an outcome and one predictor while accounting for the influence of other variables, to test whether each section-specific bias score differed between underrepresented-in-medicine applicants and non-underrepresented applicants. This approach isolates where in the document the differential language use arises, rather than merely confirming that it exists somewhere. The use of regression also helps guard against the possibility that observed differences are explained by confounding factors such as application cycle, medical school, or applicant characteristics.

The results were striking in their specificity. Applicants who identified as underrepresented in medicine had lower median overall bias scores, at 9.09, compared with white applicants, whose median overall bias score was 13.04. The same pattern appeared in the structural or summary portion of the document, where the median bias score for underrepresented applicants was 13.33 compared with 20 for white applicants. Because higher scores reflect a greater relative use of agentic language, these numbers indicate that the MSPEs of underrepresented-in-medicine applicants were written with systematically different word choices, leaning more heavily on communal descriptors and less on agentic ones. When the researchers examined the other sections of the document, the differential word use was concentrated in the summary portion, indicating that the structural or summary section is the primary source of the biased writing.

This finding carries real weight for the residency selection process. The summary section is arguably the most consequential part of the MSPE, because it is the portion that program directors most often read closely and cite when deciding whom to invite for interviews. Survey research from the National Resident Matching Program has shown that the MSPE is among the most influential documents in residency selection, and studies of program director behavior have found that the narrative evaluation can change decisions about whether to invite an applicant at all. If the language in the summary section systematically frames underrepresented-in-medicine applicants in more communal and less agentic terms, then even well-intentioned reviewers may absorb an implicit impression that these candidates are warm and dedicated but less commanding or leader-like than their peers. Such impressions, formed in seconds during application review, can compound across thousands of programs and contribute to the persistent underrepresentation of certain racial and ethnic groups in surgery.

The study also situates itself within a broader and rapidly growing literature on bias in evaluative language across medicine. Prior work has documented racial and ethnic disparities in clinical grading during medical school, gender-based differences in the language students use to describe their own noteworthy characteristics, and agentic and communal differences in letters of recommendation for applicants to radiology, urology, and surgical training programs. Researchers have shown that implicit racial bias among health care professionals influences clinical outcomes, that implicit bias affects admissions decisions, and that word embeddings trained on large text corpora can quantify decades of shifting gender and ethnic stereotypes in language. Some studies have explored whether redacting identifiers from applications can reduce biased scoring, while others have asked whether artificial intelligence tools could help mitigate bias in recommendation writing. The new study adds a crucial layer of granularity to this literature by demonstrating that bias is not diffusely spread through evaluative documents but is concentrated in the section where writers synthesize and summarize.

Why would the summary section be particularly vulnerable? The authors’ findings are consistent with what psychologists know about how stereotypes operate. When writers compile detailed evaluations from discrete clerkship assessments, they are largely transcribing and organizing specific observations, a task that anchors them to concrete performance data. When they write the summary, however, they must distill an entire career into a general characterization, and it is precisely in this act of abstraction that implicit associations are most likely to surface. The summary is also the section most likely to include comparative statements, ranking the applicant against peers, and comparative judgments are known to be especially sensitive to stereotype-driven expectations. Whatever the underlying mechanism, the practical implication is clear: interventions aimed at reducing bias in the MSPE should focus their attention on the summary and structural portion of the document, whether through structured templates, writer training that highlights agentic and communal language, or automated screening tools applied specifically to the final synthesis before the letter is released.

The researchers caution that their data, drawn from applicants to a single academic institution over two Match cycles, reflect one program’s applicant pool, and that the underlying data, obtained through the Electronic Residency Application Service and containing protected applicant information, are not available directly from the authors. Nevertheless, the scale of the sample, spanning 146 medical schools and more than 1,300 evaluations, lends considerable weight to the conclusion. The study was approved by the Institutional Review Board at Beth Israel Deaconess Medical Center and received no specific external funding. As surgery and medicine more broadly confront the persistent gap between the diversity of the population they serve and the homogeneity of their workforce, this research offers something rare in the field: a precise anatomical map of where bias hides in one of the most important documents in a physician’s career. Fixing the summary section, the study suggests, may be the single most efficient place to start.

Subject of Research: Ethnic and racial bias in the language of medical student performance evaluations for general surgery residency applicants

Article Title: Source of ethnic/racial bias in medical school performance evaluation of general surgery residency applicants

Article References: Polanco-Santana, J. C., Storino, A., Wong, D., & Kent, T. S. (2026). Source of ethnic/racial bias in medical school performance evaluation of general surgery residency applicants. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 130. https://doi.org/10.1007/s44186-026-00531-5

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00531-5

Keywords: MSPE, dean's letter, general surgery residency, ethnic bias, racial bias, agentic language, communal language, underrepresented in medicine, residency match, implicit bias, medical education, surgical workforce diversity

The numbers behind dermatology’s competitiveness explain why such an experiment matters. According to data from the National Resident Matching Program cited by the authors, 2025 saw 993 applicants competing for just 524 available dermatology residency positions, a pool that included 676 U.S. MD seniors, 105 U.S. DO seniors, and 105 U.S. MD graduates. In a field this crowded, academic excellence and extracurricular achievement are only part of the equation. Mentorship and professional networking play vital roles in building a competitive application, yet these are precisely the resources that students from rural backgrounds most often lack. The result is a self-reinforcing cycle in which the specialty that most needs rural physicians recruits the fewest of them.

That cycle has measurable consequences. The authors point to research showing that only about 6 percent of dermatology applicants plan to practice in an underserved rural region after residency, and that those who do choose that path frequently come from rural backgrounds themselves. Parallel work on the broader physician workforce has documented a decline in rural medical students, a trend that threatens the geographic diversity of the profession and, with it, access to care for millions of Americans living far from major academic centers. In dermatology, where skin cancer prevention, early detection, and chronic disease management all depend on timely specialist access, the shortage of rural-trained and rural-minded dermatologists translates directly into delayed diagnoses and preventable morbidity.

Conference participation compounds the problem. Presenting research at scientific meetings is a recognized component of a competitive residency application, offering trainees the chance to share findings, receive feedback, and build the professional connections that shape future opportunities. But as the authors note, citing recent work on the financial burdens of conference attendance, the costs of registration, travel, and lodging can be prohibitive for many students. Those barriers fall hardest on trainees in rural states, particularly at institutions without academic dermatology programs or active dermatology societies that might otherwise subsidize attendance or provide local mentorship. While virtual scientific meetings became increasingly common after the COVID-19 pandemic and measurably expanded accessibility, no conference had been dedicated specifically to rural dermatology until the RADS initiative.

The Rural Access to Dermatology Society set out to close that gap using the most accessible platform available: the virtual symposium. The stated goal was twofold. First, to give students and residents with an interest in rural dermatology a national stage on which to present their research to peers and faculty. Second, to strip away the financial and geographic barriers that keep so many trainees from participating in academic life at all. The organizing model was lean and social-media driven. A call for abstracts was posted to the RADS social media accounts and amplified by partner organizations, most notably the Dermatology Interest Group Association, a national network of student dermatology interest groups.

The response was striking for a first-time, single-topic virtual meeting. The society received 76 abstract submissions, of which 15 were selected for presentation after review by RADS board members. Selection criteria emphasized relevance to rural dermatology, scientific merit, and overall quality. Recruitment of attendees relied on posted flyers and on the promotional reach of RADS faculty within the Association of Professors of Dermatology, a national organization of academic dermatologists whose members distributed the call through their own networks. The final registration count of 108 participants spanning 32 states suggests that the demand for a rural-focused dermatology forum was real and previously unmet, drawing participants from far beyond the rural states that inspired the initiative.

The scientific program itself was structured to serve the audience on both professional and practical levels. Two keynote speakers opened the symposium with rural-focused presentations, one addressing the implementation of teledermatology, the technology-enabled remote diagnosis and management of skin disease that has become a cornerstone of rural care delivery, and the other offering a pathologist’s perspective on improving skin biopsy techniques, a topic with direct implications for diagnostic accuracy in settings where specimens travel long distances to reach a laboratory. A resident panel followed, giving attendees the opportunity to ask candid questions about what it takes to pursue a career in rural dermatology, from application strategy to life in practice outside major metropolitan centers.

The fifteen student and resident presentations reflected a surprising breadth of research approaches for such a young meeting. Survey and observational studies accounted for 40 percent of the talks, database and geospatial analyses for 26.6 percent, literature reviews for 20 percent, and conceptual or pilot frameworks for the remaining 13.3 percent. Geospatial analysis in particular is a methodologically important tool in rural health research, mapping where dermatologists practice, where patients travel for care, and where gaps in coverage are widest. Thematically, the presentations clustered into five major areas: access to dermatologic care and rural health equity, with five presentations; skin cancer prevention, education, and community outreach, also with five; rural workforce and systems innovation, with three; vulnerable and occupational populations, with two; and disease-specific outcomes research, with two.

That thematic distribution mirrors the clinical realities of rural dermatology. Skin cancer prevention and early detection remain the specialty’s most visible public health priorities in rural regions, where agricultural and outdoor occupational exposure drives elevated ultraviolet radiation risk and where dermatologists are scarce. Workforce and systems research addresses the structural question of how care can be organized, through teledermatology, task-shifting, and regional referral networks, when the specialist workforce itself is thin. Studies of vulnerable and occupational populations highlight groups, from farmworkers to remote community residents, whose skin health needs are compounded by distance, cost, and occupational exposure. Taken together, the presented work demonstrates that meaningful rural dermatology research is already being produced by trainees, often at institutions with no academic dermatology department to support it.

The authors frame the 2025 symposium as a proof of concept rather than a finished model. Future iterations will incorporate participant feedback and, importantly, will begin to assess mentorship and collaboration outcomes, moving beyond attendance metrics to evaluate whether virtual meetings actually generate the professional relationships that sustain rural research careers. If those outcomes bear out, the model could extend well beyond dermatology, offering rural-focused trainees in other specialties an accessible route into academic life. What began as a workaround for the barriers of traditional conferencing may end up reshaping who gets to participate in medical science, and ultimately, who returns to care for the communities that need them most.

Subject of Research: A virtual research symposium expanding access and education in rural dermatology for medical students and residents.

Article Title: Expanding access and education: the Rural Access to Dermatology Society (RADS) Virtual Symposium showcasing student research in rural dermatology

Article References: Salmen, N. L., & Logue, M. E. (2026). Expanding access and education: the Rural Access to Dermatology Society (RADS) Virtual Symposium showcasing student research in rural dermatology. Archives of Dermatological Research, 318(1), Article 461. https://doi.org/10.1007/s00403-026-04959-z

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04959-z

Keywords: rural dermatology, virtual symposium, medical education, health equity, teledermatology, skin cancer prevention, rural workforce, residency match, student research, conference accessibility, Expanding, access

Dermatology has long been among the most competitive specialties in the National Resident Matching Program. With a limited number of positions, high board scores historically expected, and a lifestyle that attracts large applicant pools, the field has developed one of the most demanding unofficial credential portfolios in graduate medical education. Previous analyses, including work published in JAMA Dermatology, documented a steady rise in the research output of medical students matching into dermatology between 2007 and 2018, a trend some commentators have described as research fever. The new study asks whether that fever intensified once Step 1 scores could no longer differentiate applicants numerically.

The rationale for the investigation rests on a simple structural fact. Before the transition, a high Step 1 score served as a widely used screening filter, allowing program directors to rank candidates quickly and giving applicants a clear, if stressful, way to demonstrate academic strength. When scoring became binary, that signal disappeared. Students who might once have relied on a strong score to compensate for thinner research records suddenly faced a signaling vacuum, and many appear to have responded by accelerating their publication efforts. The SUNY Downstate team set out to quantify whether the applicants entering elite dermatology programs indeed became more research-productive in the immediate aftermath of the change.

Methodologically, the researchers constructed an applicant-level dataset by tracing publication records through PubMed, the publicly accessible bibliographic database maintained by the National Library of Medicine. By linking successful applicants to the top Doximity-ranked dermatology programs with their indexed scholarly records, the team could count manuscripts, characterize authorship positions, and compare productivity across the pre-transition and post-transition eras. The compiled dataset was analyzed to detect shifts in the volume and pattern of research output, with the authors reporting their comparisons in graphical form across two figures in the short report. The use of PubMed as the source of publication records means the analysis captures indexed journal articles, the most verifiable form of student research output.

The study’s central observation is that research productivity among applicants to top-ranked dermatology programs did not decline after Step 1 became pass/fail; rather, the pressure to publish appears to have persisted or grown in the immediate post-transition period. This aligns with what residency directors anecdotally report: when one differentiator is removed from the application, others expand to fill the space. Publications, particularly peer-reviewed manuscripts with meaningful authorship roles, offer a quantifiable, durable signal of initiative, intellectual curiosity, and the capacity to complete a long-term project, qualities that a pass/fail exam can no longer convey with any granularity.

The findings carry particular weight because dermatology sits at the extreme end of the competitiveness spectrum. Prior work by Behbahani and colleagues in the International Journal of Women’s Dermatology analyzed the number of manuscripts in successful dermatology applications and found that publications were a common feature of matched candidates. A related 2025 analysis by Abizadeh and colleagues, which included several of the same SUNY Downstate investigators, documented similar dynamics in ophthalmology, another highly competitive specialty that also experienced the Step 1 transition. Together, these studies suggest a broader pattern across competitive fields: the removal of numerical Step 1 scores has shifted, not lightened, the burden of differentiation onto other parts of the application.

That shift has consequences for equity. Research productivity is not distributed evenly across medical students. Access to mentorship, dedicated research time, institutional funding, and proximity to academic medical centers all shape a student’s ability to publish before applying. Students at resource-rich institutions with established dermatology departments can more easily find projects, co-authors, and submission support, while students at schools without such infrastructure face structural barriers. If publications become the dominant differentiator in the post-pass/fail era, the authors’ findings imply that the transition may have amplified existing inequities rather than reduced them, a concern echoed in a 2023 JAMA Dermatology commentary describing research fever in dermatology as a symptom of a larger problem within the specialty’s selection culture.

The study also speaks to the ongoing debate about holistic review in residency selection. Proponents of the Step 1 pass/fail change argued that it would reduce student stress, discourage rote test preparation, and encourage programs to evaluate candidates on a broader set of attributes, including clinical performance, letters of recommendation, and personal qualities. The SUNY Downstate results suggest that at least one intended consequence, a de-emphasis on credential accumulation, has not materialized in elite dermatology recruitment. Instead, the credential economy appears to have migrated from the exam score to the curriculum vitae, with students responding rationally to the incentives programs continue to reward.

For medical educators and advisors, the practical implications are immediate. Students targeting competitive specialties now need earlier and more deliberate research planning, ideally beginning in the preclinical years, to build a publication record that can withstand comparison in a post-transition applicant pool. Programs, meanwhile, face a choice: continue to reward publication counts, thereby sustaining the arms race, or develop more structured ways to assess the quality and authenticity of research experiences, such as standardized descriptions of the applicant’s actual role and contribution. The authors of the current study, funded by the SUNY Downstate Health Sciences University Dermatology Department, frame their work as a snapshot of a system in transition, and they note that longer-term follow-up across additional match cycles will be needed to determine whether the patterns observed immediately after the change persist, stabilize, or prompt reform in how dermatology programs select the next generation of specialists.

Subject of Research: Research productivity of applicants to top Doximity-ranked dermatology residency programs in the USA before and after the Step 1 pass/fail transition

Article Title: Research productivity among applicants into top Doximity-ranked dermatology programs in the USA before and immediately after step 1 transition to pass/fail scoring

Article References: Shimshon, H. K., Berglas, R., Lavi, A. B., Berglas, E., Adler, R., Pinto, R., Musheyev, D., Shimanov, M. M., Farahmandpour, N., Inoyatov, I., & Glick, S. (2026). Research productivity among applicants into top Doximity-ranked dermatology programs in the USA before and immediately after step 1 transition to pass/fail scoring. Archives of Dermatological Research, 318(1), Article 409. https://doi.org/10.1007/s00403-026-04893-0

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04893-0

Keywords: dermatology, residency match, Step 1 pass/fail, research productivity, medical education, NRMP, publications, Doximity rankings, USMLE, competitive specialties, PubMed, SUNY Downstate