• Steven V Angus, Christopher M Williams, Emily A Stewart, Michelle Sweet, Michael Kisielewski, and Lisa L Willett.
• S.V. Angus is designated institutional official and professor, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut. C.M. Williams is a PhD student, University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, Maryland; ORCID: https://orcid.org/0000-0001-5767-8048. E.A. Stewart is associate professor of medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. M. Sweet is assistant professor, Department of Hospital Medicine, Rush University College of Medicine, Chicago, Illinois. M. Kisielewski is surveys and research manager, Alliance for Academic Internal Medicine, Alexandria, Virginia. L.L. Willett is professor, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
• Acad Med. 2020 Apr 1; 95 (4): 582-589.

PurposeTo examine internal medicine residency program directors' (PDs') screening practices and perceptions about current recruitment challenges.MethodIn March-May 2017, the Association of Program Directors in Internal Medicine Survey Committee sent a survey to 373 Alliance for Academic Internal Medicine member residency programs. PDs rated the importance of 23 inclusion and 11 exclusion criteria for interview invitation decision making, provided United States Medical Licensing Examination (USMLE) cutoff scores for U.S. medical school and international medical graduates, and indicated changes in recruitment practices due to application inflation, including their ability to conduct holistic review and interest in potential solutions to address application inflation. Exploratory factor analysis was used to identify and confirm factors that were most important to interview invitation decision making.ResultsThe response rate for eligible programs was 64% (233/363). USMLE Step 2 Clinical Knowledge scores were the criteria most frequently reported to be "very important" (131/233, 57%). Among respondents who reported any criteria as "very important," 155/222 (70%) identified a single most important (SMI) criterion. Non-USMLE criteria were frequently reported as an SMI criterion (68%). Concerning exclusion criteria, 157/231 (68%) reported they "absolutely would not invite" applicants with hints of unprofessional behavior. Of the 214/232 (92%) who reported an increase in applications, 138 (64%) adjusted recruitment practices. Respondents were most interested in limiting the number of applications per applicant (163/231, 71%), allowing applicants to indicate high interest in a subset of programs (151/229, 66%), and creating a national database of qualities of matched applicants for each program (121/228, 53%).ConclusionsPDs rely heavily on USMLE scores when making interview invitation decisions. However, collectively, non-USMLE criteria were more frequently reported as an SMI criterion. Most programs adjusted recruitment practices to respond to application volume. Several potential solutions to address application inflation garnered wide support.

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